Does Medicare Cover Hip Replacement?
The good news is: Medicare covers some of the hip replacement surgery costs if your doctor deems it medically necessary. The amount that Medicare will cover depends on your specific plan’s coverage, the procedure’s cost, and other factors. Although a Medicare plan will not cover 100 percent of the surgery cost, it certainly makes hip replacement much more affordable.
Below is a breakdown of what each Medicare plan covers:
- Medicare Part A: Part A will help pay for your stay at an approved hospital (hence why it’s so often called your “hospital insurance”). This includes hospitalization costs for your room, meals, and nursing care. Part A will also cover drugs that are part of your inpatient treatment. If you need skilled nursing care after the surgery, Part A can help cover the first 100 days of care, including physical therapy.
- Medicare Part B: While Medicare Part A covers inpatient treatment, Part B covers some of your surgery costs if is performed at an outpatient surgical facility. This includes costs like doctor’s fees, the surgery, diagnostic X-rays, follow-up treatment and care, and necessary medical equipment, such as canes or walkers.
Medicare Part C: Also known as Medicare Advantage, Part C is required to cover areas that Original Medicare ( Part A and Part B) covers. Some Medicare Advantage plans may offer additional benefits like transportation to medical appointments, meal delivery to your home after surgery, and other similar supplemental aid. A benefit of Medicare Advantage plans is that out-of-pocket costs tend to be co-payments rather than coinsurance. Co-payments are an agreed flat fee per visit or service, while coinsurance is a percentage of the overall cost.
Medicare Part D: This is a prescription drug coverage plan that can be purchased alongside Original Medicare. If you need to take pain management medication or certain prescription drugs after surgery, Part D can help cover these costs.
Medicare Supplement Insurance: Medigap plans offer supplemental coverage to Original Medicare. That means that it can help cover the cost of deductibles, co-pays, and coisnurance associated with your hip replacement care.
Bear in mind that those last three are fulfilled by a private insurance company. That means you’ll work directly with the insurance company to coordinate and pay for your care. Be sure that you’ve set up your Medicare coverage with the best additional options before you schedule your surgery. It can save your bundles. Now, you’ll likely have access to many plan options in your area. You’ll need to decide if a Medicare Advantage plan or Original Medicare with a Medicare Supplement plan is the best way to set up coverage. The answer truly depends on your needs, preferences, and budget.
Having trouble choosing? Speak to one of our licensed insurance agents by calling 1 (844) 965-1378 (TTY 711). They can guide you through the options in your area. They’ll also make sure you get a plan that fits your needs and your budget.
Out-of-pocket Costs for a Hip Replacement
Now that you know what each Medicare part covers, here’s what you can expect to pay out of pocket. Before Medicare Part A, Part B, or Part C kicks in, patients must pay any associated premiums, deductibles, or co-pays.
In 2020, the average annual deductible for Medicare Part A was $1,409 when admitted to a hospital, and the average annual Medicare Part B deductible was $198. After your monthly premiums, deductibles, and coinsurance or co-payments are made, Medicare will pay a percentage of the surgery cost. Medicaid services can help you cover even more of your care so long as you’re eligible.
Medicare can make hip replacement surgery very affordable. If you’ve been considering hip replacement surgery or think you may need one down the road, you may want to enroll in Medicare during your Initial Enrollment Period.
The Initial Enrollment Period for those eligible for Medicare begins three months before your 65th birthday and ends three months after your 65th birthday. If you already have a Medicare plan but want to switch plans—such as switching from Original Medicare to Medicare Advantage—you can do so during the Medicare open enrollment period from October 15 to December 7.