Original Medicare, which is Medicare parts A and B, will cover the cost of knee replacement surgery — including parts of your recovery process — if your doctor properly indicates that the surgery is medically necessary.
Learn more about what’s covered and what’s not, as well as other knee procedures covered under Medicare.
You will incur costs from out-of-pocket expenses associated with your knee surgery, including your Part B deductible and 20 percent coinsurance (remaining cost).
Be sure to confirm with your doctor and the hospital the exact costs for the surgical procedure and the aftercare, such as pain medication and physical therapy.
If you’ve not opted into the Medicare Part D prescription drug program, medication may be an additional expense.
Medicare Part D
Medicare Part D, an optional benefit available to everyone with Medicare, should cover necessary medications for pain management and rehabilitation.
Medicare supplement plan (Medigap)
If you have a Medicare supplement plan, depending on the details, out-of-pocket costs may be covered by that plan.
Medicare Advantage plan (Part C)
If you have a Medicare Advantage plan, based on the details of your plan, your out-of-pocket costs may be lower than with original Medicare. Many Medicare Advantage plans include Part D.
As well as knee replacement surgery, Medicare also may cover:
- Viscosupplementation. This procedure injects hyaluronic acid, a lubricating fluid, into the knee joint between the two bones. Hyaluronic acid, a key component of joint fluid in healthy joints, helps to lubricate the damaged joint, resulting in reduced pain, better movement, and a slowdown of the progression of osteoarthritis.
- Nerve therapy. This therapy involves the nonsurgical shifting of pinched nerves in the knee to alleviate pressure and reduce pain.
- Unloader knee brace. To relieve pain, this type of knee brace limits the knee’s side movement and puts three points of pressure on the thighbones. This makes the knee bend away from the joint’s painful area. Medicare covers knee braces deemed a medical necessity by your doctor.
Popular knee treatments not currently covered by Medicare include:
Knee replacement surgery that’s considered medically necessary should be covered by Medicare.
Consider contacting Medicare to make sure that knee replacement costs will be covered in your specific situation by calling 800-MEDICARE (633-4227).
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