Does Medicare Cover Knee Replacements?

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.

Physical therapist works with patient after knee replacement

How much does Medicare pay for knee replacement surgery?

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.

  • An outpatient procedure will likely be covered under Part B.

Deductibles and coinsurance may apply, whether your surgery is covered under Part A or Part B.

  • Part A requires a deductible of $1,408 per benefit period in 2020. You don't pay coinsurance for the first 60 days of an inpatient hospital stay during a benefit period.

  • Part B requires an annual deductible of $198 per year in 2020. After you meet your Part B deductible, you usually pay a coinsurance or copay amount that is typically 20% of the Medicare-approved amount.

A Medicare Supplement Insurance (Medigap) plan can help cover some of the out-of-pocket Medicare costs you may face for knee replacement surgery, such as the Part B coinsurance and your Part A deductible.

Medicare Advantage plans – which are different from Medicare Supplement plans – are required by law to provide all of the same basic benefits as Original Medicare, so a knee replacement surgery with a Medicare Advantage plan would come with identical coverage to the above.

It's important to note that Medigap plans and Medicare Advantage plans work very differently. You cannot have a Medicare Supplement plan and a Medicare Advantage plan at the same time.

Medicare Part D prescription drug coverage (which is included in most Medicare Advantage plans) helps cover prescription drugs that may be needed following knee replacement surgery.

Medicare Advantage plans cover knee replacement and have out-of-pocket spending limits

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.

What is the cost of a full knee replacement?

The average cost of a knee replacement surgery nationwide is $30,249 for an inpatient procedure, and $19,002 for an outpatient surgery.2

The average cost of a full knee replacement can range widely depending on where you live and where you get the procedure.

Does Medicare cover outpatient knee replacement surgery?

Medicare Part B will cover any outpatient surgery that is deemed to be medically necessary, including knee replacement surgeries. 

Does Medicare cover alternatives to knee replacement?

Alternatives to knee replacement surgery can include physical therapy, injections, prescription medication and durable medical equipment. 

Medicare may cover some of these alternatives under the certain circumstances. 

Medicare Part B covers outpatient physical therapy, several different types of injections and durable medical equipment. 

Medicare Part D provides coverage for prescription medication. 

Find Medicare Advantage plans that cover knee replacements and more

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.

Find Medicare Advantage plans that cover knee replacement

Compare plans now

Or call 1-800-557-6059 (TTY: 711) to speak with a licensed insurance agent. We accept calls 24/7!

 

1 Ubel, Peter. Medicare Is Reducing The Cost Of Knee Replacements (Here’s How That Could Backfire). (Feb. 10, 2017). Forbes. Retrieved from www.forbes.com/sites/peterubel/2017/02/10/medicare-is-reducing-the-cost-of-knee-replacements-heres-how-that-could-backfire/#279a55416392.

2 BlueCross BlueShield. (Jan. 23, 2019). Planned knee and hip replacement surgeries are on the rise in the U.S. Retrieved from www.bcbs.com/the-health-of-america/reports/planned-knee-and-hip-replacement-surgeries-are-the-rise-the-us.