Osteoarthritis in older adults is one of the most common reasons people need to get hip replacement surgery. Osteoarthritis causes the loss of joint cartilage in our hips, which causes a lot of pain.
If the pain gets so bad that it interferes with daily life, hip replacement surgery may be the way to go. In this surgery, the doctor will replace a damaged hip with an artificial joint. Success rates are high with this surgery, and most can resume an active lifestyle after recovering from the operation.
However, the operation is costly, and not everyone who needs it can easily afford it.
So a common question many people have is, “Does Medicare cover Hip Replacement?” In this article, we answer that question in clear, plain English. You will also find the average costs of a hip replacement surgery and other helpful info.
Does Medicare Cover Hip Replacement Surgery?
The short answer is yes; Medicare will cover the cost of hip replacement 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 hip replacement surgery. Below we look at what these are so you know what to expect.
Original Medicare (Medicare Part A and Part B) provides coverage for hip replacement surgery. Coverage for this surgery is provided by Medicare Part A if the operation takes place in a hospital or an inpatient setting. Medicare Part A will provide coverage for the following with regards to your hip replacement surgery:
- Semi-private room
- Nursing care
- Medications that you receive during your inpatient stay
Medicare Part A will also cover skilled nursing care if you need it after a hip replacement surgery. But there is a limit of 100 days of care it will cover there. One of the treatments that you may receive during your stay in a skilled nursing facility is physical therapy. And, if you do need that, Medicare Part A will provide coverage.
On the other hand, coverage for hip replacement surgery falls under Medicare Part B if it is takes place in an outpatient setting. Part B will provide coverage for the following with regards to your hip replacement surgery:
- Doctor’s Fees, including preoperative and postoperative visits
- Physical therapy
- Durable Medical Equipment or DME
Medicare Part B covers 80 percent of the costs of your hip replacement surgery. You will pay for the remaining 20 percent of the costs.
Medicare Advantage Coverage
Medicare Advantage plans (Part C) also provide coverage for hip replacement surgery. They cover everything Original Medicare covers, as well as offer some additional benefits. However, exactly what it covers and how much the out-of-pocket costs are will vary depending on the specifics of your plan.
Medicare Part C may also offer special benefits and services after your surgery. Those benefits may include:
- Non Emergency transportation to medical visits
- Meal delivery to your home
Medicare Part D usually covers medications prescribed to you after your hip replacement surgery. These may include pain management medications and blood thinners.
How Much Does Hip Replacement Surgery Cost?
Hip replacement surgery is a very expensive operation. For those who don’t have health insurance, the average cost of the surgery is around $38,000. This typically includes the initial meeting with the surgeon, x-rays or other tests, the hospital stay after surgery and more.
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.
Additional Info on Medicare Coverage
This article is part of our series on “What does Medicare cover?”
Also, you can check out other articles in this series including: Does Medicare cover 3-D mammograms?