Medicare typically covers hip replacement surgery after a doctor confirms it is medically necessary. However, the extent of the coverage can depend on numerous factors.
Hip replacement surgery can help with mobility and maintaining a healthy lifestyle. Medicare plans may cover hip replacement surgery, though coverage and eligibility can vary.
This article explains which Medicare plans cover hip replacement surgery, including specifics about the coverage, eligibility, and costs. It also explains what the surgery entails.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Original Medicare and Medicare Advantage plans help cover the costs of hip replacement surgery. Additionally, Medicare Part D provides coverage for prescription drugs that can support recovery.
There will still be out-of-pocket costs, such as deductibles and copayments. If a person has a Medicare supplement plan — also called a Medigap plan — it can help with these costs.
Original Medicare refers to Medicare Part A and Part B, which both cover various costs of the surgery. Medicare Advantage plans have to match this coverage, but they can also provide other benefits. We give a detailed breakdown of the coverage below.
During an inpatient stay at a Medicare-approved hospital, Part A covers some expenses relating to hospitalization:
- a semi-private room
- drugs that healthcare professionals administer in the hospital, including those that relieve or prevent pain and inflammation
- meals
- nursing care
If a person needs additional care, they may move into a skilled nursing facility. Medicare Part A covers the first 100 days of a stay in one of these facilities, including the cost of any physical therapy.
During days 21 to 100, Part A will cover part of the cost. A person will need to pay coinsurance.
Medicare Part B
To prepare for hip replacement surgery, a person needs minor outpatient procedures and care. This may involve:
- a general physical examination
- a full hip examination
- blood tests
- radiography
- MRI scans
Medicare Part B contributes to these outpatient costs.
When a person has left the hospital after their surgery, Medicare Part B may cover physical therapy and the cost of durable medical equipment, such as a cane or walker.
If a person has their hip replacement surgery at an outpatient surgical facility, they can return home the same day. In this case, Part B provides coverage for the associated costs.
Medicare Part D
Private insurance companies offer Medicare Part D plans. These cover prescription drugs that a person takes at home.
When recovering from a hip replacement surgery, a person may need:
- prescription pain medications, including nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin) and acetaminophen (Tylenol)
- blood thinners, such as warfarin (Coumadin), to prevent clotting
- antibiotics
- anti-inflammatories, if there is excess inflammation
Medigap
Private companies sell Medigap plans, which are supplemental insurance to help cover what Medicare does not cover with Part A and Part B. These may help with out-of-pocket costs with Original Medicare coverage. A person can use this tool to compare plans.
It may also be a suitable idea to check for any coverage through Medicaid or a spouse’s employer.
Medicare resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.
The American Association of Hip and Knee Surgeons (AAHKS) reports that the price of hip replacement surgery in the United States can be $30,000 to $112,000. The hip implant costs about $3,000 to $10,000, and the overall cost also includes staff and surgeon fees.
The average surgeon reimbursement from Medicare for this surgery is $1,375 to $1,450, according to the AAHKS.
Generally, the amount that a person with Medicare pays depends on whether they have met deductibles and premiums. A doctor can give more specific information about the cost to expect.
The annual deductible for Medicare Part A is $1,632, and for Part B, it is $240. Most people do not pay a premium for Part A. For Part B, the standard monthly premium in 2024 is $174.70.
Medicare Part A usually pays 100% of the remaining costs after a person meets the deductibles and premium. Medicare Part B pays 80%. This leaves the person to pay the remaining 20% plus their deductibles and premium.
Some hospitals have a price estimator tool that allows individuals to input their specific insurance information to provide them with a cost estimate. A person can visit their hospital website or contact the hospital for more information about this.
Hip replacement surgery, or total hip arthroplasty, involves replacing a damaged hip joint with an artificial joint.
A doctor may recommend it when other treatments and techniques have been ineffective.
Surgeons can use a traditional or minimally invasive technique. The main difference is the incision length. The conventional technique requires an incision of 8 inches (in) to 10 in along the hip joint, while the minimally invasive technique may involve a smaller incision of around 4 in to 6 in. Either type requires general or spinal anesthetic.
During the procedure, the surgeon cuts through the thigh bone and removes any damaged tissue along with the joint. Next, they attach an artificial joint to the thigh bone with surgical cement or screws. Finally, they close the muscles and skin and may insert a drainage tube.
People usually spend 1 to 4 days recovering in the hospital following the surgery. Complete recovery may take 3 to 6 months.
Learn more about hip replacement surgery.
When damage to the hip joint does not respond to other treatments, a doctor may recommend hip replacement surgery. Medicare typically provides coverage after the doctor confirms the necessity of the procedure.
The extent of Medicare coverage depends on several factors, including the person’s Medicare plans, the hospital and outpatient fees, and the state in which the surgery takes place.
People need to confirm the potential costs with their doctor and hospital before the surgery.