Does Medicare Cover Hip Replacement? (2024)

Medicare will cover hip replacements for beneficiaries when it is medically necessary. If you break a hip, a replacement may be required, and in this case, Medicare will help cover the costs of your hip replacement surgery.

The average cost of a hip replacement with Medicare may differ depending on your provider, location, and the specific procedure your physician uses. Additionally, costs can vary due to the variety of plans available and the plan you choose to enroll in. It’s important to talk to your doctor and medical team to ensure you know exactly how your coverage works before scheduling your surgery.

Original Medicare (Medicare Part A and Part B) provides benefits that can help you cover many of the associated costs of a hip replacement. For example, when performing hip replacement surgery, your surgeon will replace the hip with an artificial joint. Ceramics, hard plastic, and metal are elements in artificial joints.

Medicare Part A is great for helping seniors cover the cost of healthcare at a hospital, such as their stay and the surgery, but Part B can help pay for prosthetic pieces necessary afterward. The most common reason for a hip replacement is due to arthritis damage, according to the Mayo Clinic. Because arthritis is a common disease among seniors, this issue is prevalent for many on Medicare.

Therefore, it’s essential to understand how your benefits help you and your options for keeping healthcare costs low. Learn more about how hip surgery and Medicare work for beneficiaries.

How Much Does Hip Replacement Cost With Medicare?

Hip replacement surgery will fall under Medicare Part B, which covers 80% of your medical costs. You’ll be responsible for the remaining 20% and other cost-sharing. If you have a Medicare Supplement (Medigap) plan, the 20% coinsurance will be billed to them.

Medigap coverage helps beneficiaries by covering the costs left over by Original Medicare following healthcare. There are 12 lettered plans, and depending on what letter plan you have, you may even have all other cost-sharing covered. This means your hip replacement surgery cost will be zero. Of course, premiums and deductibles may still apply.

Does Medicare Cover Rehab After Hip Replacement?

Yes, Medicare covers rehab after hip replacement. There’s no limit on how many days Medicare Part B will cover outpatient rehab therapy as long as your doctor finds it medically necessary. For inpatient rehab, Medicare Part A will cover up to 60 days. After 60 days, you’ll have to pay coinsurance for each day.

Does Medicare Cover Outpatient Hip Replacement?

Yes, Original Medicare covers outpatient hip replacement through Medicare Part B. Additionally, if you have a Medigap policy, your benefits also cover the leftover hip replacement costs that are paid out-of-pocket.

How much Medicare covers for hip replacement outpatient procedures may partially depend on which Medicare Supplement plan you are enrolled with. Medicare Advantage may also be able to help, but you can only enroll in either Advantage or Medigap, not both at the same time. Speaking with an agent can help you determine the best coverage for your needs.

Does Medicare Cover Hip Injections?

Yes, so long as they are medically necessary, Medicare will cover hip injections. Patients suffering from hip problems may hear that injections are a “middle-of-the-road” treatment. Medications and physical therapy are the first steps; then, surgery is a last resort.

But the good news is that Medicare will cover some hip injections. The two most common hip injections include:

1. Platelet Rich Plasma (PRP) has been in the surgery world for 20+ years. But to the orthopedic world, it’s a newer method of treatment. The treatment uses the patient’s own immune system’s platelets found in the blood, then injected into the problem joint area. Healing happens through this stimulating of more collagen.
2. Stem Cell Injections are “magic cells” that can multiply to help heal a wounded area. Injecting these anti-inflammatory and regenerative cells into a joint with arthritis may treat the area. This method doesn’t have FDA approval. Therefore, coverage isn’t available.

The less frequent injections include cortisone injections and Viscosupplementation injections. These may or may not be more beneficial for you; talk with your doctor to discuss your options.

Does Medicare Cover Cortisone Shots?

Medicare guidelines state that cortisone injections usually have coverage. Unlike prescription drugs, which Medicare Part D covers, this medication treats inflammation and is administered by a medical professional. Therefore, Original Medicare will provide coverage. Be sure to check with your medical provider and ask what the Medicare allowable amounts are for each service.

How Many Cortisone Shots will Medicare Cover?

Beneficiaries needing cortisone shots may have coverage for three cortisone shots annually. Repetitive injections may cause damage to the body over time.

Therefore, many orthopedic surgeons suggest such a low number for each patient per year. Medicare Part B pays for the administration of any cortisone injections if a healthcare provider administers the drug.

The Knee Gel Injections Cost Medicare Covers

Hyaluronic acid injections, a gel-like substance, receive Medicare coverage for treating knee osteoarthritis when medically necessary. Yet, hyaluronic acid/sodium hyaluronate injections don’t have FDA approval for use in the hips or other joints.

There isn’t sufficient evidence for the effective treatment of hip osteoarthritis nor temporomandibular joint osteoarthritis, or disc displacement. Thus, it is not a practical, long-term solution for hip joint pain.

Does Medicare Cover Hip and Knee Replacement Surgery?

Yes, Medicare will cover the cost of hip replacement surgery and knee replacement surgery. We’ve already covered hip replacements and Medicare, but knee replacement works in a similar fashion:

• To receive coverage from your Medicare benefits, your knee replacement must be considered a medically necessary procedure by your doctor.
• Original Medicare provides coverage for such healthcare, and Medigap or Medicare Advantage may also help cover costs.
• The best way to determine which benefits best protect you from such medical costs is to speak with a licensed Medicare agent.

Best Medicare Supplement Plan For Hip Replacement

While 20% of services may not seem like a lot left over to pay, many seniors are living on a fixed income. Procedures, services, and injections can cost upwards of hundreds, sometimes even thousands of dollars. Luckily, Medicare Supplement will cover the 20% coinsurance as well as additional cost-sharing in the form of deductibles and copays.

But there are several different Medigap plans available. Some will offer more benefits than others, while others aim to keep costs low for beneficiaries. The best Medicare Supplement plan for hip replacement is going to be the plan that best fits your overall healthcare needs and budget.

Choosing the right benefits is a big step, and the decision you make will affect the care you receive along with your finances. This is why it’s always advised to speak with a licensed Medicare agent before enrolling. By doing so, you can identify your healthcare needs, such as a hip replacement, and choose a plan that keeps you covered for less.

Is a Hip Replacement Considered Medically Necessary?

Yes, a hip replacement may be considered medically necessary. According to the Centers for Medicare & Medicaid Services (CMS), for the purposes of Medicare, a Total Hip Arthroplasty will help alleviate pain and improve functionality for beneficiaries. If your doctor determines that a hip replacement is necessary for your health, it’ll be deemed as such and covered by Medicare.

Medicare Plan G and Hip Replacement

Medicare Plan G, formally known as Medicare Supplement Plan G, covers all of your cost-sharing minus the Part B deductible. Medigap Plan G is one of the most comprehensive supplemental plans available and has increased in popularity as Medicare Supplement Plan F has restricted who can enroll. Speak with a licensed Medicare agent to determine which Medigap plan works best for your needs.