Original Medicare (Part A and Part B) will typically cover hip replacement surgery if your doctor indicates that it is medically necessary. This does not mean, however, that Medicare will cover 100 percent of the costs. Instead, your costs will be determined by your specific plan coverage, the cost of the procedure, and other factors.
Read on to learn more about what to expect.
Medicare Part A
According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, people typically need to stay in the hospital for 1 to 4 days following a hip replacement. During your stay at a Medicare-approved hospital, Medicare Part A (hospital insurance) will help pay for:
- semi-private room
- nursing care
- drugs that are part of your inpatient treatment
If you need skilled nursing care following the procedure, Part A helps cover the first 100 days of care. This can include physical therapy (PT).
Medicare Part B
If your hip replacement is performed at anoutpatient surgical facility, Medicare Part B (medical insurance) should helpcover the costs of your care. Whether your surgery is done at a hospital oroutpatient facility, Medicare Part B will typically help pay for:
- doctor’s fees (pre and post-op visits, post-op physical therapy, etc.)
- durable medical equipment (cane, walker, etc.)
Medicare Part C
Medicare Part C, also known as Medicare Advantage, is required to cover at least as much as original Medicare (parts A and B).
Medicare Advantage plans may also offer additional benefits. These benefit may include nonemergency transportation to medical visits, meal delivery to your home after inpatient discharge, and other services you may need after hip replacement.
Medicare Part D
Medicare Part D is prescription drug coverage that can be purchased from a private insurance company separately from original Medicare. Part D typically covers the post-operative drugs that are not covered by Medicare, such as pain management medications and blood thinners (to prevent clotting) taken during your recovery.
Summary of coverage by Medicare
|Medicare part||What’s covered?|
|Part A||Help with costs associated with hospital stay, such as a semi-private room, meals, nursing care, drugs that are part of your inpatient treatment and up to 100 days of skilled nursing care, including physical therapy, following surgery|
|Part B||Help with costs associated with outpatient procedure, and doctors’ fees, surgery, physical therapy and medical equipment (canes, etc)|
|Part D||Post-operative drugs, such as prescribed medications for pain management or blood thinners|
According to the American Association of Hip and Knee Surgeons (AAHKS), the cost of a hip replacement in the US ranges from $30,000 to $112,000. Your doctor will be able to provide the Medicare-approved price for the specific treatment you need.
Before Medicare Part A and Part B pay any partof that price, you must have paid your premiums and deductibles. You will alsohave coinsurance or copayments.
- In 2020, the annual deductible for Medicare Part A is $1,408 when admitted to a hospital. That covers the first 60 days of hospital care in a benefit period. About 99 percent of Medicare beneficiaries do not have a premium for Part A according to the U.S. Centers for Medicare & Medicare Services.
- In 2020, the monthly premium for Medicare Part B is $144.60 and the annual deductible for Medicare Part B is $198. Once those premiums and deductibles are paid, Medicare typically pays 80 percent of the costs and you pay 20 percent.
If you have additional coverage, such as a Medigap policy (Medicare Supplement Insurance),depending on the plan, some of all of your premiums, deductibles, and copaysmay be covered. Medigap policies are purchased through Medicare-approvedprivate insurance companies.
Determining your cost
To find out how much your hip replacement willcost, talk to your doctor. The specific amount you’ll pay may depend on things,such as:
- other insurance coverage you may have, such as a Medigap policy
- the amount your doctor charges
- whether or not your doctor accepts assignment (the Medicare-approved price)
- where you get the procedure, such as a Medicare-approved hospital
Hip replacement surgery is used to substitute diseased or damaged parts of a hip joint with new, artificial parts. This is done to:
- relieve pain
- restore hip joint functionality
- improve movement, such as walking
The new parts, typically made of stainless steel or titanium, replace the original hip joint surfaces. This artificial implant functions similarly to a normal hip.
According to the
Original Medicare (Part A and Part B) will typically cover hip replacement surgery if it’s medically necessary.
Your out-of-pocket costs for your hipreplacement will be impacted by a number of variables, including:
- any other insurance, such as Medigap
- Medicare and other insurance deductibles, coinsurance, copays, andpremiums
- doctor charges
- doctor acceptance of assignment
- where the procedure is performed