Does Medicare cover hip replacement?

The hip joint is 1 of the largest joints in the body. If it becomes worn down due to age or inactivity, or damaged due to a fall, sometimes the only treatment option is surgery. Hip arthroplasty, more commonly known as hip replacement surgery, is when a surgeon replaces damaged or worn parts of your hip joint with artificial parts. These new parts are usually made of metal, ceramic or plastic.
 

How much does a hip replacement cost with Medicare?

Based on national averages, the cost for a total hip replacement in an outpatient surgical center is $10,502. Medicare pays $8,401 and the patient owes the balance of $2,099.

For a total hip replacement in a hospital outpatient department, the average total cost is $13,803. Medicare pays $11,918 and the patient owes $1,884.¹

Note: You can contact Medicare directly to learn what hip replacement surgery costs may be covered in your situation. You can reach Medicare at 800-MEDICARE (800-633-4227, TTY: 877-486-2048). You can also visit Medicare’s procedure price look-up webpage to learn more.

Hip replacement surgery is covered like any other medically necessary surgical procedure.

Part A (hospital insurance)

If you have your hip replacement surgery as an inpatient in a hospital, Part A will help pay for your hospital costs once you meet your Part A deductible.

Part B (medical insurance)

If you have surgery as an outpatient, Part B helps pay your outpatient surgery costs. According to the American Academy of Orthopaedic Surgeons, many surgeons now perform a majority of their total hip replacements as outpatient same-day surgeries, and it is projected that 51% of joint replacements will be done on an outpatient basis by 2026.²

Part C (Medicare Advantage)

Medicare Advantage (MA) plans are required by law to cover everything Original Medicare Part A and Part B cover. In addition, some MA plans may offer added benefits like nonemergency transportation to medical visits, meal delivery to your home after inpatient discharge, and other services you may need after hip replacement.

Part D (prescription drug coverage)

Your doctor may prescribe antibiotics, blood thinners and pain medication to aid in your recovery. Whether you have a stand-alone prescription drug plan or receive Rx benefits as part of a Medicare Advantage plan, it’s easy for you and your doctor to determine which brand name or generic drugs are covered by your plan.

Medicare Supplement

Many Medicare members opt for Original Medicare and buy a separate Medicare Supplement Insurance plan to help with certain out-of-pocket healthcare costs. Depending on your plan choice, a Medicare Supplement plan may help with copays, coinsurance and deductibles.
 

Understanding your Medicare options during a hip replacement

Total joint replacement is 1 of the safest and most reliable treatments in any area of medicine. Talk to your doctor to understand how your coverage works before you schedule your surgery.