Does Medicare Cover Hip Replacement?

• by Christian Worstell
• January 12, 2024
• Reviewed by John Krahnert

Original Medicare (Part A and Part B) does cover hip replacement surgery if your doctor says it is medically necessary.

Medicare Advantage plans (Medicare Part C) can also cover hip replacement.

Medicare Advantage plans also offer annual out-of-pocket spending limits and may offer benefits not found in Original Medicare.  

How much does hip replacement surgery cost?

A damaged hip joint can be replaced with an artificial prosthesis in order to alleviate pain and help patients enjoy a better quality of life.

The Centers for Disease Control and Prevention state that more than 325,000 hip replacements may be completed in a single year.¹ More than half of those are for patients 65 or older — people who are eligible for Medicare due to age.

The average cost of a hip replacement surgery can be more than $40,000.²

The significant cost of a hip replacement procedure is one reason to make sure you understand your Medicare coverage.

What do you pay for hip replacement surgery if you have Medicare?

If you undergo hip replacement surgery and are admitted as a hospital inpatient, you can expect both Medicare Part A and Medicare Part B to contribute to your care.

You could be responsible for meeting both Medicare Part A and Part B deductibles, as well as any applicable copayments or coinsurance. If you are an outpatient, your bill may look different.

The price of hip replacement surgery can vary by provider, and your out-of-pocket responsibilities can differ based on how you receive your Medicare benefits. Talk to you doctor to ensure you understand how your coverage works before you schedule your surgery.

Medicare Advantage plans can cover hip replacement surgery

Because Medicare Advantage plans cover the same benefits that are offered by Medicare Part A and Part B, a Medicare Advantage plan may also cover hip replacement surgery if it is medically necessary.

If you have a Medicare Advantage plan (Medicare Part C), you may have to pay deductibles, copayments and coinsurance in accordance with your particular plan.

Medicare Advantage plans also include an out-of-pocket spending limit, which Original Medicare doesn't offer. This can help protect you from out-of-pocket hip replacement surgery costs that can add up quickly.

Ready to enroll in a Medicare Advantage plan? Give a licensed insurance agent a call today to discuss your options and find a plan in your area that works for your healthcare needs.

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

¹ Centers for Disease Control and Prevention. Hospitalization for Total Hip Replacement Among Inpatients Aged 45 and Over: United States, 2000-2010. (Feb. 2015). Retrieved from www.cdc.gov/nchs/products/databriefs/db186.htm.

² Charles, Shamard, MD. In and Out: Hip surgery in the morning, home by night. (Dec. 22, 2017). NBC News. Retrieved from www.nbcnews.com/health/health-news/out-hip-surgery-morning-home-night-n823021.

About the author

Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.

Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.

Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.

Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.

A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.

If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@tzhealthmedia.com.

 

 

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