The cost of a knee replacement can vary substantially, even within the same geographical area. The final hospital charge depends on many factors, including:
- number of days spent in the hospital: This will vary depending on the type of knee replacement you have (total, partial, or bilateral).
- type of implant and surgical approach: This includes the material the implant is made of and if any customized surgical instruments or specialized computer technology used.
- pre-existing conditions: You might require extra care in the hospital or additional precautions during surgery.
- length of time spent in the operating room
- unanticipated care or equipment required: Complications you experience during your hospital stay might call for it.
- pre-surgery doctor visits and lab work
- the surgery and the time you spend in the operating room, including charges for the anesthesia and other tools used
- your hospital stay
- post-surgery doctor visits
- physical therapy
The average hospital charge for a total knee replacement (TKR) in the United States is $49,500. A partial knee replacement (PKR) typically costs about 10 to 20 percent less than a TKR. The main reason is that the operation requires a shorter hospital stay. For example: an average of 2.3 days, compared to 3.4 days. Keep in mind that hospital charges don’t reflect the amount you pay out of pocket. Out-of-pocket costs are explained in more depth below.
You should expect multiple bills following a knee replacement surgery, including:
- hospital bills
- bills for all treatments you received from the surgeon while in the hospital
- other tasks and procedures performed by the operating room staff (This includes work done by the anesthesiologist, surgical assistants, physical therapists, and others.)
Inpatient charges are charges that occur while you’re in the hospital. Inpatient charges from the surgeon and other healthcare providers may add an average of roughly $7,500 to the basic hospital charge for the procedure. This brings the average total charges for a TKR in the United States closer to $57,000.
Hospitals will sometimes provide discounts if you don’t have health insurance or aren’t covered by Medicare. Ask about a possible discount or payment plan before scheduling your surgery if you don’t have insurance coverage. You should try to estimate your costs in advance whether or not you have insurance.
Speak with your doctor, a hospital representative, and your insurance provider before surgery to learn the expected average charges for your area. It’s important to know what will be covered and what discounts will be applied.
Once you’ve reached your deductible, Medicare typically pays 100 percent of inpatient charges related to a procedure and the hospital stay. Private insurance plans pre-negotiate fees with hospitals and providers. They usually only pay a percentage of the total charges.
Private insurance varies. It’s important to review your benefits plan before scheduling a knee replacement. Understand your deductible, which providers are in your insurance network, and what services will be covered.
Inpatient procedure and hospital charges represent the largest portion of your incurred charges. But you should also know that you’ll be charged for outpatient services before and after your procedure. “Outpatient” refers to services that occur when you’are not in the hospital.
These additional TKR expenses include:
- pre-operative and post-operative costs from office visits and lab work
- physical therapy
- follow-up visits with your surgeon during your recovery
Medicare typically pays 80 percent of the outpatient service charges for its members. Private insurance plans vary. You should expect deductibles and copays to apply to any outpatient or office visit charges before and after your surgery.
Understanding Your Bill
Bills vary, but here’s what you generally can expect if you receive a knee replacement:
The pre-surgical evaluation phase consists of a consultation or office visit, imaging, and lab work. The lab work usually includes blood work, cultures, and panel tests.
The number of expected services and the total charges vary by insurance coverage and age group. For example, someone over the age of 65 (usually covered by Medicare) generally requires more lab work than someone under 65. This is because an older adult is more likely to have pre-existing conditions that must be understood fully during a pre-operative evaluation.
The approximate national average charge for these services, according to what typically occurs within the 90 days prior to surgery, is $1,900 for Medicare patients and $1,000 for those with private insurance.
Hospital Stay and Surgery
You’ll receive separate bills for a TKR. As discussed above, the hospital will bill you for your hospital stay, time spent in the operating room, and other applicable hospital services, supplies, and equipment used.
Providers will bill you for procedure charges that cover services provided by the surgeon, as well as:
- pathology services
- surgical assistance (for example, operation of computer aided or other technology)
- physical therapy
- coordination of care
The approximate national average charge for these services is $56,000 for Medicare patients and $58,300 for those with private insurance.
Keep in mind that there are many other factors that can affect charges and costs related to a procedure, including:
- pre-existing conditions: For example, anemia can increase a hospital charge by as much as 17 percent. Doctors and hospitals also call these pre-existing diagnoses, or comorbidities. Examples of other comorbidities are hypertension, smoking, obesity, and diabetes.
- complications: Anything that creates a need for additional attention or extra care may lead to an increase in charges.
Recovery and rehabilitation encompasses:
- outpatient physical therapy services
- the tools and treatments used in physical therapy
- outpatient follow-up
The approximate national average charge for these services is $2,600 for Medicare patients and $1700 for those with private insurance. These costs are based on what’s typical over 12 months after surgery.
The average patient out-of-pocket expense in the United States ranges dramatically and ultimately depends on your insurance plan. Medicare patients can expect their out-of-pocket costs to be in the hundreds of dollars.
Those with private insurance can expect these costs to reach into the thousands. Review your plan carefully if you’re covered by private insurance. Remember that your deductible, copay, co-insurance, and max out-of-pocket values will come into play.
Keep in mind that the cost of care and services is only part of the overall expense. For example, your doctor will also probably prescribe special equipment, such as a continuous passive motion machine, walker, or crutches. Most insurance plans and Medicare cover these devices (referred to as “durable medical equipment”). However, they may lead to additional charges that appear on your hospital bill or another bill.
You may also require additional physical therapy or a nurse in your home. Your home may require modifications. This could include installing:
- safety bars and rails
- a shower bench
- a toilet seat riser with arms
- maybe other items
Expect to pay out of pocket if your insurance doesn’t cover home-care services. You should also expect separate bills if you’re unable to return home immediately and are released to a rehab or nursing facility for extra care.
Factor in lost income if you take time off from work for the surgery or during recovery. Talk to your employer and insurance provider to find out if you qualify for any disability insurance options that cover time off work.
Disability insurance is a form of insurance that pays out a partial wage to employees who can’t work because of an injury or disability. It may cover time off needed for surgeries such as TKRs.
Options to Save Money
Some patients opt to have their TKR performed overseas. The cost of the surgery can drop by 50 to 80 percent in countries like Mexico, India, or Taiwan. If you’re considering taking this route, make sure that the facility is internationally accredited by the Joint Commission International (JCI) before agreeing to the procedure. This means the surgeons are accredited and that the facilities and prosthesis meet the highest standards. Keep in mind that you’ll likely spend several thousand dollars for airline tickets, hotels, and related expenses.
By knowing the costs up front, you can avoid surprises — and potential hardship — down the line.