What Does Medicare Pay for a Hip Replacement?
- 4 days ago
- 1 min read
A hip replacement may reduce severe pain, improve mobility, and help older adults return to daily activities. Many patients naturally ask, what does Medicare pay for a hip replacement? Medicare generally helps cover the procedure when it is medically necessary and ordered by a Medicare-approved physician.
Your doctor must document why surgery is needed. Common reasons may include advanced arthritis, joint damage, persistent pain, or limited mobility that has not improved with medication, therapy, injections, or other conservative treatments.
What Does Medicare Pay for a Hip Replacement Under Original Medicare?
The amount Medicare pays depends partly on whether the surgery is performed as an inpatient or outpatient procedure.
If you are formally admitted to the hospital, Medicare Part A may help cover the hospital stay, operating room services, nursing care, medications received during the admission, and other medically necessary inpatient services.
If the procedure is performed on an outpatient basis, Medicare Part B may help cover the surgeon, outpatient facility, medical testing, and related approved services. After the Part B deductible is met, patients with Original Medicare generally pay 20% of the Medicare-approved amount.
Your final out-of-pocket cost may also depend on the hospital or surgical center, your surgeon, additional testing, and whether you have Medigap or Medicare Advantage coverage.
Before scheduling surgery, ask whether you will be considered an inpatient or outpatient and request a personalized cost estimate. This can help you understand what Medicare may cover and what you may need to pay.
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