Does Medicare Cover Hip and Knee Replacement?

Original Medicare — Medicare Part A and Part B — cover a wide variety of costs associated with hip and knee replacement surgery, also called lower extremity joint replacement or LEJR.

A Medicare Part D plan can help cover prescription drugs related to your hip or knee replacement surgery, while a Medicare Supplement (Medigap) plan helps cover the out-of-pocket costs not covered by Original Medicare.

Medicare Advantage plans must cover what Original Medicare does, but may include additional benefits.

Medicare Part A is hospital insurance. It covers costs associated with your hospitalization for hip or knee replacement surgery.

Typically, a hip or knee replacement requires you to stay in the hospital for one to four days. Medicare will cover a share of certain approved costs during your stay.

Medicare Part B is medical insurance. It typically covers doctor visits and medical services. It also helps pay for the medical costs of knee and hip replacements.

Medicare will only pay for prosthetics when they are ordered by a doctor or other health care provider approved by Medicare. And the device has to come from a supplier that is also enrolled in Medicare.

Medicare Advantage plans are sold by private insurers and are required to cover everything that Original Medicare does, so your plan will cover at least what Medicare Part A and Part B cover.

But Medicare Advantage plans may also provide benefits that Original Medicare does not cover. These may include nonemergency transportation to doctor appointments or other medical visits associated with your joint replacement.

Some Medicare Advantage plans may also cover meal delivery services while you are at home recuperating from the surgery.

Medicare Part D prescription drug plans are sold by private insurers. Since Medicare Part A only covers medications you receive while in the hospital, a Part D plan can help cover the costs of prescription medicines you may need after your knee or hip replacement.

Medigap — also known as Medicare supplemental insurance — policies are sold by private companies and can help pay your out-of-pocket costs associated with Original Medicare.

Some, but not all, Medigap policies may pay your Medicare Part A and Part B deductibles along with copayment or coinsurance costs. The amount a policy pays varies from plan to plan.

You should check with your Medigap policy’s administrator to determine what costs are covered.

While Medicare covers much of the cost for approved hip or knee replacement, you will still have to pay deductibles, copayments and coinsurance.

The amount you owe will depend on the type of Medicare coverage you have.

Medicare covers some but not all popular alternatives to hip and knee replacement surgery.

Remember, if your doctor recommends a knee or hip replacement, not all alternatives may work for your particular situation. Alternatives may not be possible depending on how extensive your joint damage has become.

You should check with your doctor and with your Medicare plan to see if alternatives are covered under your plan.

You should also check with your plan administrator if you have a Medicare Advantage plan, Medicare Part D prescription drug plan or Medigap policy to see how much your plan will pay and how much you are responsible for if you are having alternative treatments.