Does Medicare Cover Hip Replacement and Associated Costs?

In this article...
  • Hip replacement involves replacing the hip with artificial parts. Does Medicare cover hip replacement? Learn the answer to this question and more in this article.

Medicare does cover hip replacement as long as a physician confirms the procedure is reasonable and medically necessary and the beneficiary's symptoms haven't improved sufficiently through other treatment methods. While Medicare covers the costs of this procedure, the beneficiary may still be responsible to pay some of the costs.

What Is Hip Replacement?

Hip replacement is a surgical procedure in which the natural hip joint is replaced with an artificial joint made of steel and titanium. People may benefit from hip replacement if they're experiencing pain and limited mobility due to injury or conditions including osteoarthritis, rheumatoid arthritis and bone tumors.

Some surgeons may conduct hip replacement surgery in a hospital, and people spend one to four days recovering in the hospital. Others perform the procedure in an outpatient setting. Complete recovery may take three to six months.

Medicare Coverage for Hip Replacements

Medicare covers hip replacement costs for hospitalization, medical care and medications. Each part of Medicare pays for certain charges incurred in the hip replacement process.

Medicare Part A

Medicare Part A pays for hospital costs, so hip replacements carried out in a hospital setting are covered under Medicare Part A. The procedure must take place in a Medicare-approved hospital. Medicare Part A covers:

  • A semi-private room with a private bath
  • Food
  • Nursing care
  • Medications, such as drugs needed to alleviate pain and inflammation, necessary for the beneficiary's treatment while hospitalized

Medicare Part A covers the first 100 days in a skilled nursing facility in case a beneficiary needs specialized care when recuperating from hip replacement surgery.

Medicare Part B

Medicare Part B helps pay for medical care provided outside the hospital setting. If the hip replacement procedure takes place in an outpatient facility, Medicare Part B helps pay for these charges. Other costs covered under Medicare Part B may include:

  • Preoperative and postoperative doctor visits
  • Imaging tests
  • Blood tests
  • Physical therapy
  • Durable medical equipment, such as a cane or walker

Medicare Part D

Medicare Part D provides coverage for medications a beneficiary needs at home while recovering from hip replacement surgery. These may include:

  • Pain relievers
  • Anti-inflammatory medications
  • Blood thinners
  • Antibiotics

Beneficiary Costs for Hip Replacement

Medicare Part A

Beneficiaries must pay a deductible for each benefit period before Medicare Part A benefits apply. Coinsurance costs may be applicable for beneficiaries with hospitalization periods exceeding 60 days.

Medicare Part B

Medicare Part B pays 80% of the approved amounts for medical care, outpatient care and durable medical equipment after the beneficiary pays an annual deductible. This means that once the beneficiary pays the annual deductible, they're also responsible for paying 20% of the Medicare-approved amount.

Medicare Part D

Each beneficiary selects a Medicare Part D plan annually, choosing the one that best suits their needs. Approved medications, deductibles and copays vary depending upon the plan.

Factors Affecting Beneficiary's Out-of-Pocket Costs

Medicare covers hip replacement, but it doesn't cover the entire cost. The beneficiary is responsible for certain deductibles and copays. However, some beneficiaries have Medigap or Medicare Advantage plans, and these may help pay for some of the costs Medicare doesn't cover.

Beneficiaries seeking hip replacements should also ensure the doctors and medical facilities they select are Medicare-approved and accept Medicare assignment. Practitioners and facilities not approved by Medicare may charge fees in excess of Medicare's approved amounts, and the beneficiary may be responsible to pay those additional fees.

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