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.
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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.
Deductibles and coinsurance may apply, whether your surgery is covered under Part A or Part B.
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.
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.
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.
Medicare Part B will cover any outpatient surgery that is deemed to be medically necessary, including knee replacement surgeries.
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.
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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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.
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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