Does Medicare cover the cost of a hip replacement surgery?

Yes. Medicare usually covers the cost of total hip replacement surgery. The procedure must be medically necessary. Medicare Part A covers hospital stays, while Part B covers outpatient care and doctor services related to the surgery.

Which parts of Medicare cover pre- and post-operative care for a hip replacement?

Medicare Part B covers pre- and post-operative rehabilitation and doctor visits during your recovery time. Part A takes care of inpatient hospital states, skilled nursing facility care, and some associated costs for home healthcare.

What costs can I expect for a hip replacement if I am a Medicare recipient?

Your costs for hip surgery range from $1,632 to around $2,100 with Original Medicare. But your expenses can vary depending on your coverage, and you may pay less if you have a Medigap policy or Medicare Advantage plan.

Are there specific hip replacement procedures that Medicare doesn’t cover?

Yes. Medicare doesn’t cover hip replacements if they’re elective, for cosmetic purposes, or performed outside the United States. For Medicare to authorize the surgery, it must be medically necessary and you must have a history of a reasonable attempt at conservative treatments.

What are the steps to ensure Medicare will cover my hip replacement?

To ensure hip replacement coverage, it’s a good idea to work with your doctor to document treatments. You may need three months (or more) of medical records to show that you tried non-surgical treatments. Choose a Medicare-approved hospital and surgeon, and check with Medicare or your insurance company to confirm coverage before the procedure.

Does Medicare Cover Hip Replacement?

Written byAmy Beardsley

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Updated July 9, 2024

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When it’s covered
When it isn’t covered
Medigap and MA plans
FAQs

When it’s covered
When it isn’t covered
Medigap and MA plans
FAQs

Medicare typically covers hip replacement surgery, but the coverage details can be a bit tricky. Your doctor has to say the surgery is medically necessary, and even then, Medicare might not pay for everything. This includes costs before and after the surgery.

Learn how Medicare can help cover a hip replacement, what costs you might have to pay yourself, and when Medicare might not cover the surgery.

When does Medicare cover hip replacement surgery?

Medicare covers hip surgery if it’s “medically reasonable and necessary.”^[1] This means the surgery should help reduce pain, restore function, or improve mobility when other treatments, like physical therapy or prescription drugs, haven’t worked.

Hip replacement is a major surgical procedure, and you usually need to stay in the hospital for one or two days afterward. But some people can have outpatient joint replacement and go home the same day.

Medicare Part A (hospital insurance) covers your hospital stay, including the surgery, hospital room, meals, nursing care, and prescription medications you receive while in the hospital.^[2] Medicare Part B helps pay for outpatient services, like physical therapy, medical equipment, and other post-operative care you might need.^[3]

Good to Know

Medicare Advantage (MA) plans, also known as Medicare Part C, combine Medicare Part A and B. While they follow Medicare rules, some plans might have lower out-of-pocket expenses for hip replacements than Original Medicare.

But a Medicare Advantage plan can limit your care to certain in-network doctors and facilities.

Additional costs Medicare won’t cover

While Medicare coverage takes care of most hip replacement costs, some expenses fall to the patient. The amount you’ll pay depends on a few factors, including the type of facility in which you have your procedure — a surgical center or hospital.

If you have the surgery at an ambulatory surgical center, your out-of-pocket cost will be roughly $2,100 with Original Medicare. At a hospital outpatient setting, the surgery costs about $1,632, which is nearly $500 less.^[4]

These prices are based on the 2024 national average and don’t include physician fees, physical therapy, rehab costs, or additional procedures if needed.

When Medicare won’t cover a hip replacement

Medicare’s coverage pays for the cost of hip replacement surgery only if it’s medically necessary. Here are some situations when Medicare may not pay for this common procedure:

Elective surgery
Medicare usually wants you to try at least three months of non-surgical treatments, including physical rehabilitation or medication, before approving the surgery. Three months may seem like a long time, but skipping this step could deem your procedure “elective.”
Cosmetic reasons
Medicare won’t cover the procedure if you’re having surgery to improve your appearance and not to help with pain management or function.
Lack of medical proof
If you can’t provide imaging or records showing that non-surgical treatments didn’t work, Medicare might not cover the surgery.
Outside the U.S.
Medicare usually doesn’t cover surgeries done outside the United States.

Medigap and Medicare Advantage plans for hip replacement

A Medigap (Medicare Supplement plan) or Medicare Advantage (Part C) plan can be your best option to help cover some of the out-of-pocket costs for joint replacement.

Medigap plans are available from private insurance companies and work with Original Medicare (Part A and B). They can pick up the tab for deductibles, copayments, and other medical expenses. Keep in mind that Medigap plans don’t usually include prescription drug coverage, so you may need a separate Medicare Part D plan for that.

Private medical insurance companies also offer Medicare Advantage plans. But these plans act as an alternative to Original Medicare. They combine Part A, Part B, and often Part D coverage.

Depending on your plan, Medicare Advantage plan out-of-pocket costs might be lower than Original Medicare. But some plans require prior approval or referrals from your primary care provider.