Original Medicare covers knee replacement surgery if it is considered to be medically necessary by your doctor. Both Medicare Part A and Medicare Part B (Original Medicare) may each cover different aspects of the procedure.
Medicare Advantage plans (Medicare Part C) can also cover knee replacements. Many Medicare Advantage plans also cover benefits such as bathroom grab bars in your home and home meal delivery when you return home from an inpatient hospital stay.
Medicare typically covers a number of surgeries that are considered medically necessary, including knee and other joint replacement surgeries. How much Medicare will pay for your knee replacement surgery depends on where you receive the procedure.
If you get your surgery in a hospital and are admitted as an inpatient, you can expect both Medicare Part A and Part B to contribute. Part A will help pay your hospital costs, and Part B will cover medical costs associated with the procedure.
If you have a Medicare Advantage plan, your plan will offer the same benefits as Original Medicare. Medicare Advantage plans also include out-of-pocket spending limits, which could help you pay less out of pocket for your knee replacement surgery.
For both Original Medicare and Medicare Advantage plans, deductibles, coinsurance and copayments may apply.
Knee replacement surgeries are common in the United States. According to Forbes, more than one million knee replacement procedures were completed between 2005 and 2015. Many of the people who received these surgeries were Medicare beneficiaries.1
If you receive the surgery in an ambulatory surgery center or outpatient setting, you may pay a different amount.
Because Medicare Advantage plans must offer the same benefits as Medicare Part A and Medicare Part B, your Medicare Advantage plan should cover your knee replacement surgery if a doctor says it is medically necessary.
If you’re eligible for Medicare enrollment or are interested in changing to a Medicare Advantage plan, call a licensed insurance agent today to see what Medicare Advantage plans are available in your area.
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