Understanding Knee Replacement Costs: What’s on the Bill?

Depending on where you get the surgery, knee replacement can be expensive.

In fact, the United States has the highest average total cost of a TKR at $19,568 among countries, according to an analysis from 2023.

Another cost analysis comparing the cost of knee replacements without complications in American hospitals found an average cost of $68,016 within a large range of 39,927-$195,264.

A partial knee replacement (PKR) typically tends to cost less than a TKR, especially if the procedure can be outpatient. For example, Blue Cross Blue Shield estimated in 2019 that the average cost of an inpatient knee replacement procedure was $30,249, compared with $19,002 as an outpatient.

Keep in mind that hospital charges don’t reflect the amount you pay out of pocket. In most cases, your private health insurance or Medicare will cover most of the cost, but there will still be payments to make if you have a copay or if you haven’t met your deductible.

Medicare

Hospitalization is covered under the Part A part of Original Medicare. The cost of the monthly premium in 2024 ranges between $278-$505, depending on your work history and income.

Part A

That said, you can get Part A for free if you’ve accumulated at least 40 calendar quarters (10 years) of work and made Medicare tax payments during that period. You will then only have to pay a deductible of $1,632 upon admission to the hospital.

Once you’ve reached your deductible, Medicare Part A typically pays 100% of inpatient charges related to a procedure and the hospital stay.

Part B

Meanwhile, Medicare Part B will generally pay 80% of the cost of the services by doctors during your hospitalization, such as the surgery itself and the administration of any related medications. Note that your procedure must be deemed medically necessary for Medicare to cover it.

For the first 60 days after meeting your Part A deductible during the benefit period, you won’t need to make any more payments beyond what remains after Medicare kicks in. Most people who undergo a knee replacement are released within a few days.

Part B will also cover outpatient treatment, which refers to services that occur when you’re not in the hospital.

These additional expenses include:

• pre- and postoperative costs from office visits and lab work
• physical therapy
• follow-up visits with your surgeon during your recovery

Part C

If you have a Medicare Advantage (Part C) plan, it is required to offer similar coverage to Original Medicare (Parts A and B).

In addition, you can purchase a Medigap plan to offset some of the remaining costs.

Private insurance

Private insurance plans pre-negotiate fees with hospitals and providers. They usually only pay a percentage of the total charges.

According to KFF’s 2023 Employer Health Benefits Survey, the average coinsurance rate, which is the percentage your insurance pays out of the cost of the medical treatment, for a hospital admission is 20%. The average copayment amount, which is the amount you would pay out of pocket, is $404.

That said, every plan is different, and the coverage varies, so it’s important to review your benefits plan before scheduling a knee replacement.

Check the following points before making your decision:

• your deductible
• which providers are in your insurance network
• which services your insurance covers

Learn more: Medicare vs. private insurance.

The cost of a knee replacement can vary widely, depending on where you live, which clinic you use, your overall health, and other factors.

What contributes to the cost?

The final hospital bill will depend on many factors, including:

• Number of days you spend in the hospital: This will depend on whether your knee replacement is total, partial, or bilateral.
• Type of implant and surgical approach: This includes the material the implant is made of and the use of any customized surgical instruments or specialized computer technology.
• Preexisting conditions: You might need extra care in the hospital or additional precautions during surgery.
• Time spent in the operating room: If the damage is complex, it can take longer to operate, and this will be more costly.
• Unanticipated care or equipment: If complications occur, you may need additional care.

Multiple bills

There will usually be multiple bills after a knee replacement surgery, including those for:

• hospital care
• all treatments from the surgeon while in the hospital
• other tasks and procedures performed by the operating room staff

Other tasks and costs include work done by the anesthesiologist, surgical assistants, physical therapists, and others.

Bills vary, but here’s what you generally can expect if you have a knee replacement:

Presurgical preparation

The presurgical 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 total charges varies 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 preexisting conditions that must be understood fully during a presurgical evaluation.

Hospital stay and surgery

You’ll receive separate bills for a TKR. As discussed above, the hospital will bill you for your stay, time spent in the operating room, and other applicable hospital services, supplies, and equipment.

Providers will bill you for procedure charges that cover services provided by the surgeon, as well as:

• anesthesia
• injections
• pathology services
• surgical assistance, for example, operation of computer-aided or other technology
• physical therapy
• coordination of care

Keep in mind that many other factors can affect charges and costs related to a procedure.

Complications can affect anyone, but people with preexisting conditions may be more susceptible. If complications occur, you may need additional care, and this will add to your bill.

Diabetes, obesity, and anemia are all examples of preexisting conditions.

Postsurgical care

Recovery and rehabilitation include:

• outpatient physical therapy services
• any tools and treatments the physical therapist uses
• outpatient follow-up

Totals

The average out-of-pocket expense in the United States ranges widely. It’ll depend on your insurance plan.

For Medicare patients, out-of-pocket costs may be in the hundreds of dollars. Those with private insurance can expect these costs to reach the thousands, but it depends on your insurance plan.

Review your plan carefully if you have private insurance. Remember to factor in your deductible, copay, coinsurance, and max out-of-pocket values.

The cost of care and services is only part of the overall expense.

Equipment

There may be extra payments for special equipment, known as durable medical equipment, such as a walker, ice machine, or crutches. Generally, Medicare covers this under Part B, whereas private insurance coverage varies.

Home care services

Many insurance plans and Medicare cover these devices. However, they may appear as additional charges on your hospital or another bill.

You may also need additional physical therapy or a nurse in your home.

Expect to pay out of pocket if your insurance doesn’t cover home care services.

There will be additional costs if you’re unable to return home immediately and need to spend time in a rehab or nursing facility for extra care.

Home modifications

You may need to install safety equipment in your home, such as:

• safety bars and rails
• a shower bench
• a toilet seat riser with arms

Remember to factor in lost income if you take time off from work for the surgery or during recovery. Talk with 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 type 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 that you need for surgeries such as TKRs.

Learn more about how to prepare your home for your recovery.

Hospitals sometimes provide discounts if you don’t have health insurance or aren’t covered by Medicare.

Start by asking about a possible discount or payment plan before scheduling surgery if you don’t have insurance coverage. You should try to estimate your costs in advance whether or not you have insurance.

Some people also opt for surgery overseas. The cost may be significantly lower in countries like Mexico, India, or Taiwan. However, you may spend several thousand dollars on airline tickets, hotels, and related expenses.

If you’re considering taking this route, make sure that the facility has international accreditation by the Joint Commission International before agreeing to the procedure.

If it does, this means the surgeons are accredited and that the facilities and prostheses meet the highest standards.

By knowing the costs upfront, you can avoid surprises — and possible hardships — down the line.

The average cost of a TKR in the United States is almost $20,000.

Your bill for a TKR will include both pre- and postsurgery costs, as well as the price of the surgery itself, with charges including pre-surgery doctor visits and lab work, the surgery itself, and the anesthesia used during the procedure, your hospital stay, and postsurgery doctor visits, and more.

Medicare will usually pay for the procedure and most of the related services as long as it is medically necessary. Many private insurance companies will do so as well, but it depends on your specific plan.

Most people will have an out-of-pocket cost of about 20% unless you’ve already paid your deductible, in which case the surgery should be covered 100%.