Does Medicare Cover Orthopedic Surgery?

Orthopedic surgery can be performed on many parts of the body. Knees and hips being two of the most common. Both surgeries treat osteoarthritis. They are also both expensive, costing tens of thousands of dollars. And not everyone who needs them can easily afford them.

So a common question many people have is, “does Medicare cover orthopedic surgery?” In this article, we answer that question in clear, plain English. You will also find the average costs of some orthopedic surgeries and other helpful info.

Does Medicare Cover Orthopedic Surgery?

The short answer is yes; Medicare will cover the cost of orthopedic surgery. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met in order for Medicare to pay for your orthopedic surgery. Below we look at what these are so you know what to expect.

Original Medicare

Original Medicare (Medicare Part A and Part B) provides coverage for orthopedic surgeries such as hip and knee replacement surgeries. Medicare provides coverage for hip replacement surgery if it is considered medically necessary by your healthcare provider.

Coverage for hip replacement surgery is provided by Medicare Part A if it takes place in an inpatient setting. Some of the things Medicare Part A will cover include a semi-private room and nursing care. Medicare Part A also provides coverage for 100 days of skilled nursing facility stay after hip replacement surgery.

On the other hand, Medicare Part B provides coverage for hip replacement surgery if it takes place in an outpatient setting. Medicare Part B coverage for your outpatient hip replacement surgery includes the doctor’s fee and durable medical equipment such as a wheelchair.

Just like with hip replacement surgery, Original Medicare provides coverage for knee replacement surgery if your healthcare provider says it is medically necessary.

Coverage for knee replacement surgery is provided by Medicare Part A if it takes place in an inpatient setting. Some of the things Medicare Part A will cover include a semi-private room and nursing care.

On the other hand, Coverage for hip replacement surgery is provided by Medicare Part B if it takes place in an outpatient setting. Medicare Part B also covers durable medical equipment that you will use after knee replacement surgery.

Part C and Part D Coverage for Orthopedic Surgery

Medicare Advantage plans (Medicare Part C) also provide coverage for orthopedic surgeries. They cover everything Original Medicare covers, as well as some additional benefits. However, exactly what it covers and your out-of-pocket costs will vary depending on the specifics of your plan.

Medicare Part D plans provide coverage for prescription medications that you may need after hip or knee replacement surgery.

How Much Does Hip And Knee Replacement Cost?

For those without insurance, a hip replacement surgery may cost somewhere from $30,000 to $112,000. On the other hand, knee replacement ranges from $45,000 to $70,000.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.