Does Medicare Cover Hip Replacement Surgery?
Key takeaways:
Original Medicare and Medicare Advantage cover hip replacement surgery that is considered medically necessary.
If your hip replacement surgery is an inpatient procedure, it will be covered by Medicare Part A. Hip replacement surgery performed in an outpatient setting is covered by Medicare Part B.
Medicare also covers costs associated with your recovery, including physical therapy and equipment.
Table of contents
It’s hard to keep moving when chronic hip pain grinds you down. Hip replacement surgery is common among Medicare enrollees who suffer from osteoarthritis and other conditions.
Original Medicare and Medicare Advantage plans cover surgeries, including hip replacement, when they are deemed medically necessary. In fact, hip, ankle, and knee replacements are the most common surgeries for people enrolled in Medicare. Medicare also covers the therapy and equipment you need to recover.
Expect a hip replacement with original Medicare to cost you about $2,100 or less out of pocket, depending on whether your procedure is in an inpatient or outpatient setting.
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Does Medicare cover hip replacement surgery?
Yes. Medicare covers hip replacement surgery when it is considered medically necessary, from “prehab” before the procedure to postsurgery rehabilitation. That means your presurgical visits, hip surgery, and recovery are covered under the different parts of Medicare.
There are several kinds of hip replacement surgery, including:
Total hip arthroplasty (THA), in which the entire joint is replaced
Revision hip arthroplasty, also called revision THA or THA revision
Partial hip arthroplasty, also known as hemiarthroplasty
The American Joint Replacement Registry (AJRR) Annual Report, produced since 2013 by the American Academy of Orthopaedic Surgeons, provides a snapshot of U.S. knee and hip replacement surgeries covered by Medicare. Among procedures reported by participating surgeons in 2022, most were total knee replacements.
U.S. hip replacement or revision surgeries in 2022
Type of surgery | Procedures performed* | Percentage** |
Total hip arthroplasty (THA)*** | 111,645 | 77% |
THA revision | 12,375 | 9.8% |
Partial hip replacement revision | 10,379 | 8.7% |
Hip resurfacing | 46 | 0.5% |
Source: American Joint Replacement Registry 2023 Annual Report
*The number of procedures is less than the U.S. total because the chart includes only surgeries covered by Medicare and performed by surgeons who responded to the AJRR survey.
**Doesn’t include all hip arthroplasty procedures performed by AJRR surgeons.
***Includes elective primary THA but not THA for fracture.
If you have original Medicare, the part of your insurance that will cover your hip replacement surgery depends on where you have the procedure performed. If your hip replacement is an inpatient procedure, your care will be covered by Medicare Part A. Outpatient procedures are covered by Medicare Part B.
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Medicare Part A
Medicare Part A, which is hospital insurance, will cover your inpatient hip replacement surgery. You will pay a Part A deductible of $1,632 per benefit period in 2024 for days 1 to 60 that you’re in the hospital. If you recover at a skilled nursing facility, you don’t have any coinsurance for days 1 to 20 during your benefit period.
Medicare Part B
The Medicare Part B deductible is $240 in 2024. After you meet your deductible, Medicare pays 80% of allowed charges and you pay 20%.
How much does hip replacement cost with Medicare?
It depends. Your out-of-pocket costs for hip replacement will vary depending on where you have your procedure.
With original Medicare, expect to pay about $2,100 out of pocket for total hip replacement at an ambulatory surgery center.
Your deductible is $1,632 in 2024 for inpatient services under Medicare Part A. After this deductible, Medicare covers further inpatient services, like rehabilitation or physical therapy.
Hip replacement surgery for original Medicare enrollees can cost about the same (about a $500 difference) whether you have the procedure at a hospital or an ambulatory surgery center, according to Centers for Medicare & Medicaid Services (CMS) estimates.
Estimated cost sharing for total hip arthroplasty for original Medicare enrollees
Ambulatory surgical centers | Hospital outpatient departments | |
Surgeon fee | $1,264 | $1,264 |
Facility fee | $9,238 | $12,539 |
Total | $10,502 | $13,803 |
What Medicare covers (80%) | $8,402* | $11,918** |
What you pay (20%) | $1,632 in 2024*** |
*Because of a rounding error, the CMS site shows different numbers.
**Average Medicare payment as reported by CMS for this procedure.
***Original Medicare caps your costs in hospital outpatient procedures. So instead of paying $2,761, which is 20% of the total, you would likely pay no more than the $1,632, which is the Part A deductible in 2024.
If you have Medicare Advantage, your out-of-pocket costs may be more or less than the estimates above, depending on your plan. You can estimate your cost sharing for the procedure by looking for pricing information on your plan’s website or by contacting your plan administrator.
Choosing a facility for your surgery
Medicare also provides a checklist for talking with your healthcare provider about how to choose a facility and check coverage for your outpatient procedure, if you qualify for one.
Factors that affect your out-of-pocket costs include:
Where the procedure is done and whether it’s an inpatient or outpatient procedure (a hospital stay under 24 hours)
If inpatient, length of hospital stay
The kind of implant used
Whether you have complications
Whether you have supplemental insurance, known as Medigap
How much will Medicare pay for?
As mentioned above, Medicare will cover 80% of hip replacement surgery costs after you meet your Part A deductible. According to Medicare’s price procedure lookup tool, that leaves about $2,100 or less for the Medicare enrollee to pay.
On average, Medicare pays between $8,402 (at the ambulatory surgical center) and $11,918 (at a hospital outpatient department). Typically, patients will have an out-of-pocket responsibility of around $2,100 (at the ambulatory surgical center) and $1,632 (at the hospital).
Which parts of Medicare cover hip replacement?
Original Medicare (Parts A and B) covers hip replacement surgery, but you’ll also likely use the other parts of Medicare to pay for other expenses associated with your new hip. Here’s a look at how the different parts of Medicare cover hip replacement:
Part A
As mentioned earlier, Medicare Part A handles hospital costs related to hip replacement surgery. Under Part A, you’ll pay a $1,632 deductible for each benefit period (covered episode). There’s no coinsurance until after the 60th day you’re hospitalized (and you shouldn’t be in the hospital that long for a hip replacement). Part A also covers limited stays at a skilled nursing facility if needed.
Part B
As mentioned above, Medicare Part B covers expenses such as doctor services, as well as outpatient therapy and durable medical equipment (DME). The Part B deductible is $240 in 2024. After you pay the deductible, you’ll usually pay 20% of the Medicare-approved amount.
Medicare Advantage (Part C)
Medicare Advantage, a private alternative to original Medicare, often has copays or set dollar amounts you pay for services. Compared with original Medicare’s coinsurance percentage, a copay may be able to help you better predict costs. Medicare Advantage plans also limit your annual financial responsibility, which is known as the out-of-pocket maximum.
Part D
Part D pays for prescription medications you’ll need after your hip surgery. How much you pay depends on your plan’s formulary and how much you’ve spent on prescriptions that year, which determines the phase of Part D coverage you’re in.
Medigap
Medicare supplement insurance, known as Medigap, can help original Medicare enrollees cover some or all of their out-of-pocket costs, including deductibles and coinsurance. This is important because original Medicare doesn’t have an out-of-pocket limit.
What is the process of getting hip replacement surgery covered by Medicare?
First, you need to find a surgeon who takes Medicare, which is known as “accepting assignment” — and most do.
Your surgeon will decide if a hip replacement is medically necessary. If you want a second opinion, however, Medicare Part B covers a second opinion at 80%, so you would pay 20% coinsurance after meeting the Part B deductible. If the two opinions are different, Medicare will even cover a third opinion.
Medicare Advantage plans may have different rules about how they cover extra assessments and may require prior authorization or preapproval of your procedure.
Does Medicare cover physical therapy after hip replacement surgery?
Yes. Medicare covers physical therapy and occupational therapy after hip replacement. You may also qualify for care in a skilled nursing facility or rehab center — or certain home care, including part-time skilled nursing. For instance, you would qualify for skilled nursing care and inpatient rehab if you had surgery in a hospital setting.
How do you dispute a charge when you have Medicare?
Monitor your quarterly Medicare summary notice (MSN). This document shows which medical services and items have been billed to Medicare in the last 3 months on your behalf. Your MSNs come in the mail or to your online Medicare account. Check to make sure the charges are correct. If you have a Medigap policy, the MSN shows you which out-of-pocket costs your Medigap plan is expected to cover.
If you spot an error, you can challenge the charge or coverage decision through the Medicare appeal process, which is different depending on whether you have original Medicare or Medicare Advantage.
If you need help with coverage or have cost questions, you can contact your local State Health Insurance Assistance Program for free one-on-one counseling on Medicare matters. Or contact Medicare at 1-800-633-4227.
What does Medicare not cover in regard to hip replacement?
Medicare generally covers the expenses for hip replacement. But atypical situations can make hip replacement surgery financially unpredictable.
As mentioned, Medicare will cover inpatient physical therapy and care in a skilled nursing facility for a limited time, but it won’t likely cover your care in a nursing home.
DME, such as a walker or a wheelchair, may be needed during your recovery. Medicare covers many kinds of DME, but only if you have a prescription from a doctor and both your doctor and the DME supplier are participating in Medicare. If your supplier doesn’t accept the price Medicare is willing to pay, you could be left to pay the entire bill.
Medicare has a DME supplier directory and cost comparison tool on its website.
Medicare may not cover all the DME or adaptive equipment your healthcare providers recommend for your recovery.
One option is to purchase a hip kit to help you dress and bathe yourself as you recover. A hip kit often includes items such as:
A grabber/reacher
A long-handled sponge or brush for bathing
A sock aid
A long-handled shoehorn
Elastic shoelaces
Hip kits range from $20 to $50 or more. You may be able to find most of these items at a medical equipment loan program near you.
Other home safety items that can be helpful but aren’t typically covered are medical equipment that may be useful but isn’t considered medically necessary, such as grab bars, stair elevators, raised toilet seats, and a handheld shower head.
If you have Medicare Advantage, your plan may cover these extra benefits. There are also assistance programs to help prepare your home for aging in place.
The bottom line
If you require medically necessary hip replacement surgery, Medicare will cover most expenses. If you have original Medicare, a Medigap plan can help you cover out-of-pocket costs associated with your surgery.
Medicare also covers durable medical equipment, such as a walker, as well as physical therapy and skilled nursing care. Medicare doesn’t cover some items you may need during your recovery, such as a hip kit and adaptive devices.
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References
American Academy of Orthopaedic Surgeons. (n.d.). The American Joint Replacement Registry 2023 Annual Report.
Baum, J. (2022). Does Medicare cover hip replacements? eHealthInsurance Services.
Center for Medicare Advocacy. (n.d.). Medicare prior authorization.
Centers for Medicare & Medicaid Services. (n.d.). Comprehensive care for joint replacement model.
Centers for Medicare & Medicaid Services. (2023). Medicare & home health care.
Centers for Medicare & Medicaid Services. (2023). Transparency in coverage.
Humana. (n.d.). Medicare coverage for durable medical equipment.
Medicare.gov. (n.d.). Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty), with or without autograft or allograft.
Medicare.gov. (n.d.). Costs.
Medicare.gov. (n.d.). Does your provider accept Medicare as full payment?
Medicare.gov. (n.d.). Durable medical equipment (DME) coverage.
Medicare.gov. (n.d.). Inpatient rehabilitation care.
Medicare.gov. (n.d.). Nursing home care.
Medicare.gov. (n.d.). Second surgical opinions.
Medicare.gov. (n.d.). Skilled nursing facility (SNF) care.
Medicare.gov. (n.d.). Surgery.
Medicare.gov. (n.d.). Which facility is best for my outpatient procedure?
Medicare Interactive. (n.d.). Maximum out-of-pocket limit.
Sheth, N. P., et al. (2023). Hip resurfacing. American Academy of Orthopaedic Surgeons.
