Original Medicare only helps pay for surgical procedures that are medically necessary. Your doctor would need to determine that your knee surgery is medically necessary.
In certain situations, Original Medicare (Parts A and B) may help pay some of the costs of knee replacement surgery.
Let’s explore some important details and potential costs of this procedure.
Yes, but the surgery must be medically necessary
What can affect the cost of knee replacement surgery
Personal factors that can impact the cost include:
- Where you live
- Where you have the surgery
- Your overall health
- Preexisting conditions
Medical factors that can affect the cost include:
- Length of time in the operating room
- Type of implant and surgical approach
- Type and amount of anesthesia
- X-rays during and after the procedure
- Medications to manage pain and prevent infection
- Unanticipated care or equipment
- Inpatient hospital days and outpatient therapy services
What Medicare may help pay
You’ll likely have to pay a deductible, coinsurance and/or copayments for your surgery, but here’s what Original Medicare may cover:
- Part A (hospital insurance) helps pay your inpatient stay costs once you meet your Part A deductible.
- Part B (medical insurance) helps pay your outpatient surgery costs after you meet your Part B deductible. Part B may cover 80% of all allowable charges for medically necessary doctor visits and physical or occupational therapy services after your surgery.
Note: You can also contact Medicare directly to learn what knee replacement surgery costs may be covered in your situation. You can reach Medicare at 800-MEDICARE (800-633-4227, TTY: 877-486-2048).
Learn more about Medicare
For more helpful information on Medicare, check out these 10 frequently asked questions about Medicare plans.
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