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POINTS
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If the surgery is deemed to be medically necessary then Medicare may cover some expenses, including where the surgery takes place and how long the recovery may be.
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Medicare Part A may cover the procedure if performed in a Medicare-approved hospital which can include a private room, drugs administered during the stay, meals, and nursing care.
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Medicare Part B may cover the procedure if taken place as an outpatient surgery, which can include physical therapy, post-surgical appointments, imaging, medical testing, and durable equipment that may be of use after.
Extreme pain and limited mobility of the hip joint can affect your quality of life. When physical therapy, medication, use of walking aids and other alternative treatments such as injections haven’t helped to improve your joint mobility and reduce pain, your doctor may recommend surgery. Luckily, Medicare does cover some of the expenses for an Arthroplasty.
When Does Medicare Cover Hip Replacement Surgery?
Medicare will provide coverage for hip replacement surgery when it applies to the following:
- It has been deemed reasonable and medically necessary.
- While every person’s situation is unique, typically a doctor will determine that hip replacement surgery is reasonable and medically necessary when other alternative treatments, such as physical therapy, injections, and medications, have been tried but there has been no improvement or changes in symptoms.
What Part of Medicare Covers Hip Replacement Surgery?
Hip replacement surgery can be performed both as an inpatient and outpatient procedure. The part of Medicare that covers the cost of your hip replacement surgery will depend upon where your procedure is being performed. Most hip replacements surgeries require a one-night stay while some patient may go home the same day or stay longer.
Medicare Part A will cover some of the expenses if your procedure is performed in a Medicare-approved hospital. Medicare Part B will cover some of the medical expenses if your procedure is performed in a facility that is outside of a hospital, such as an outpatient surgical center.
If you need prescription medication after an outpatient hip replacement surgery, Medicare Part D can cover some of the costs of medications while you are at home.
What Does Medicare Part A Cover for Hip Replacement Surgery?
Medicare Part A will cover hip replacement surgery if it is deemed reasonable and medically necessary. The procedure must be performed in a Medicare-approved hospital. Some of the medical expenses and other expenses that Medicare Part A will cover during your inpatient hospital stay includes:
- Semi-private hospital room that has a private bathroom.
- Drugs administered to you during stay such as anti-inflammatories, blood thinner and pain relievers.
- Meals
- Nursing Care
Additionally, if your doctor or surgeon determines that you need additional care because of your hip replacement surgery, Medicare Part A will cover some of the cost of a stay in a skilled nursing facility for up to 100 days. Physical therapy is included in the coverage provided by Medicare Part A when you stay in a skilled nursing facility.
What Does Medicare Part B Cover for Hip Replacement Surgery?
Medicare Part B will provide coverage for some of the medical expenses you experience because of outpatient hip replacement surgery. Some of the expenses that are covered by Medicare Part B include:
- Cost of the procedure including use of outpatient facility, a surgeon, and other medical staff.
- Physical therapy
- Post-surgical appointments with doctors and surgeon.
- Imaging
- Medical testing
- Durable medical equipment such as walkers or canes.
What Other Expenses Does Medicare Cover for Hip Replacement Surgery?
If your healthcare provider needs you to have a medical exam or other testing performed before your hip replacement surgery, Medicare Part B may cover some of the expense of this testing. Common testing that may be required for hip replacement surgery include:
- Preoperative physical exam
- EKG
- Blood testing
- Imaging such as x-rays, CAT, or MRI.
In addition, if you need any type of medication to help with pain management or to reduce complications from your procedure, Medicare Part D may help save you money by covering some of the expenses. Some of the most common medications used after hip replacement surgery include pain medicine, antibiotics, anti-inflammatories, and blood thinners.
How Much Will It Cost for Hip Replacement Surgery?
The average out-of-pocket cost for Medicare enrollees according to Medicare.gov is $2,027 in a non-hospital facility not requiring more than 24 hours of care (ambulatory surgical center) or $1,748 for surgery done at an outpatient hospital department. Those costs are national averages, based on Medicare’s 2021 payments and copayments. How much you will have to pay for your hip replacement surgery and any other related expenses will vary depending upon your situation. Some factors that determine how much you will have to pay for this procedure include:
- Cost of the procedure and hospital charges.
- Whether your healthcare provider accepts Medicare-approved prices.
- Deductibles
- Co-pays
- Coverage from additional insurance plans such as Medigap or a spouse’s private health insurance.
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