Does Medicare Cover Hip Replacements?

Pamela Cannaday by Pamela Cannaday | Licensed since 2011
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This article was updated on: 09/10/2018

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Original Medicare, Part A and Part B, may cover medically necessary surgery and related doctor’s services, and this may include hip replacements. Medicare Advantage and Medicare Supplement may also cover some costs associated with a hip replacement.

What is a hip replacement?

According to the U.S. National Library of Medicine, hip replacement is for people with severe hip damage, usually caused by osteoarthritis. During a hip replacement surgery, your damaged cartilage and bone are removed and the hip are replaced with man-made parts. Hip replacement parts are comprised of a ball component made of a strong metal or ceramic material and a socket component made of plastic, ceramic or metal according to the American Academy of Orthopedic Surgeons. The U.S. National Library of Medicine reports that a hip replacement can relieve pain and improve walking and other movements associated with the hip.

How much do hip replacements cost?

According to the business magazine Forbes in 2015, the average cost for a hip replacement procedure is $30,124, including hospitalization, surgery, and rehabilitation. Hip replacement cost can vary by location, notes Forbes. Hip replacement surgery can be as little as $16,000 in Alabama and as much as $60,000 in New York. Keep in mind this is total cost, not out-of-pocket cost for a hip replacement patient who has Medicare.

How much do hip replacements cost under Medicare?

In general, hip replacement surgery is reserved for people whose condition has not responded to other treatments such as physical therapy, pain medication and exercise. To qualify for hip replacement surgery, your doctor will have to provide detailed information and medical records showing that joint replacement is medically needed in your case. Even if your surgery is approved, you may have to pay the Part A and/or the Part B deductibles before Medicare will pay, plus you may have copayments due. After your hip replacement surgery, Medicare Part A may cover any time you have to spend in the hospital recovering as well as physical therapy you may receive in a skilled nursing facility. Medicare Part B covers outpatient physical therapy up to therapy caps. According to the Centers for Disease Control and Prevention (CDC), the average length of time spent in a hospital after a hip replacement is just under four days.

Before scheduling a hip replacement surgery, it’s a good idea to get an estimate of costs and find out what your coverage options are. You can learn more about Medicare out-of-pocket costs here.

You may consider expanding your Original Medicare coverage with additional insurance, such as a Medicare Supplement plan (Medigap) that can help pay for deductibles and copayments for your hip replacement procedure. Or you may be interested in a Medicare Advantage plan, which has the same the same coverage as Original Medicare and may offer more benefits.

Do you have more questions about Medicare coverage of hip replacements?

If you’d like some help figuring out which Medicare plan option may fit your needs, feel free to contact me.

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Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the Federal Medicare program.

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