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.