Coverage

Does Medicare Cover Hip Replacement?

Medicare may cover hip replacement surgery if it is medically necessary. Medicare Advantage plans can also cover hip replacement surgery and may offer additional benefits.

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.

Many Medicare Advantage plans also offer annual out-of-pocket spending limits and benefits such as bathroom grab bars in your home, both of which are not covered by Medicare Part A or Part B.

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Doctor points out woman's hip on X-ray

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.

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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 https://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 https://www.nbcnews.com/health/health-news/out-hip-surgery-morning-home-night-n823021.

Christian

About the author

Christian Worstell is a licensed insurance agent and a Senior Staff Writer for MedicareAdvantage.com. He is passionate about helping people navigate the complexities of Medicare and understand their coverage options.

His work has been featured in outlets such as Vox, MSN, and The Washington Post, and he is a frequent contributor to health care and finance blogs.

Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism. He currently lives in Raleigh, NC.

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