Does Medicare Cover Hip Replacements?

Written by:

Casey Max

Reviewed by:

Jason Kolkey

5 min read

Key Takeaways

Surgeries such as hip replacement can be covered by Original Medicare (Parts A and B) or by a Medicare Advantage (Part C) plan.
In this procedure, a surgeon replaces the damaged hip joint with an artificial implant.
When a hip replacement is considered medically necessary, it may be covered by Medicare Part A for an inpatient operation at a hospital or by Part B if it’s an outpatient surgery.
Medicare Advantage plans must at least match the surgery coverage provided by Original Medicare.

If you’re wondering whether Medicare will cover your hip replacement, the answer is usually yes. Surgeries can be covered by Original Medicare (Parts A and B), the public health insurance program for people 65 and older or with certain disabilities, or by a Medicare Advantage (Part C) plan, an alternative to Original Medicare offered by private insurance carriers.

To qualify for covered services, your doctor must sign off on the surgery as medically necessary. Depending on your situation, this may mean showing that less invasive treatments like physical therapy or medication didn’t improve your hip’s condition.

Let’s dig into the details of Medicare coverage for hip replacement surgery.

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Who Needs a Hip Replacement?

The average age of patients who receive hip replacement surgery is about 67 years old, and most U.S. adults become eligible for Medicare at 65. According to the Centers for Medicare and Medicaid Services (CMS, the federal agency that administers Medicare), hip replacement, also called total hip arthroplasty, is one of the most common surgeries for people on Medicare.

In this procedure, your surgeon replaces the damaged hip joint with an artificial implant consisting of a ball (made of metal or ceramics) and a socket (made of plastic, metal, or ceramics).

A hip replacement can relieve pain and improve mobility for those dealing with arthritis, injury, or other hip problems. The procedure may be necessary if your pain interferes with everyday activities like walking and makes it difficult to sleep. Before recommending surgery, your doctor might first try other treatments like medications to manage pain or inflammation and physical therapy.

Hip replacements are not only common but also life-changing for many Medicare beneficiaries. Understanding your Medicare coverage can help you plan for surgery and recovery.

How Original Medicare Covers Hip Replacements

Medicare Part A, which is hospital insurance, covers your surgery if you are checked in as an inpatient at the hospital. After you meet the deductible, the amount you pay before insurance kicks in, Part A covers up to 60 days in the hospital.

Some hip replacements are outpatient surgeries that don’t require an overnight hospital stay. Outpatient procedures are covered under Medicare Part B, which is medical insurance. Part B also covers outpatient services once you are released from the hospital, such as follow-up care like physical therapy or durable medical equipment like a walker or wheelchair. For most services and equipment covered by Part B, you pay coinsurance, a portion of the Medicare-approved cost, after meeting your annual deductible.

To qualify for a Medicare hip replacement coverage, you must meet one or more of the following criteria:

Cancer in the bones or soft tissue of the hip area.
Avascular necrosis, a condition that occurs when blood supply to the area is cut off, resulting in bone death.
Femoral neck fracture, a break in the upper femur connected to the hip joint. This type of injury most often occurs after a fall.
Acetabular fracture, a break in the hip socket.
Failure to heal properly from a previous fracture or surgery.
Advanced joint disease, a chronic disease in which the cartilage at the ends of your bones breaks down.

Before recommending surgery, doctors usually need to try medication or therapy for at least three months.

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How Medicare Advantage Covers Hip Replacements

Private insurance carriers offer Medicare Advantage plans, also called Medicare Part C, as a substitute for Medicare Parts A and B. These plans are legally required to offer, at minimum, the same level of coverage as Original Medicare. Coverage details vary depending on which plan you choose, and only certain plans are available to you based on where you live and your individual situation.

Unlike Original Medicare, a Medicare Advantage plan sets an annual limit on your out-of-pocket costs. In addition, plans may offer a variety of extra benefits that can help you through recovery from surgery. However, to get the most out of your insurance, you will need to visit doctors, facilities, and pharmacies that are in your plan’s provider network.

How Much Hip Replacements Cost With Medicare

When you receive outpatient surgery, Medicare Part B covers 80% of the Medicare-approved cost, and the patient is responsible for the remaining 20%.

The cost of your hip replacement surgery varies depending on the type of facility where the procedure is performed. Here’s a breakdown of the average costs for hip replacements with Medicare as of 2024:

Hip replacement cost at an ambulatory surgical center:

Total Cost: $10,502 ($9,238 facility fee, $1,264 doctor fee)
Medicare Pays: $8,401
Patient Pays: $2,099

Hip replacement cost at a hospital outpatient facility:

Total Cost: $13,803 ($12,539 facility fee, $1,264 doctor fee)
Medicare Covers: $11,918
Patient Covers: $1,884

Medicare Advantage plans must offer at least the same level of coverage as you would get through Original Medicare, but the exact costs may vary based on your plan.

Other Benefits to Consider

If you are recovering from major surgery like a hip replacement, you may need other benefits that Original Medicare or Medicare Advantage provide.

Care at a skilled nursing facility: When medically necessary, Medicare Part A covers 100% of the first 20 days of care if you meet certain requirements, such as a qualifying hospital stay of at least three days.
Physical therapy: Medicare Part B will cover 80% of the costs for medically necessary physical therapy to help you recover movement in your body. There’s no limit for how much Original Medicare spends on outpatient therapy per year.
Occupational therapy: With Medicare Part B, you pay 20% of the cost for therapy to regain the ability to perform daily tasks after surgery.
Home health services: If you are homebound and need part-time medical assistance, Medicare covers at-home services like nursing, physical therapy, and occupational therapy. Certain Medicare Advantage plans may provide additional help.
Durable medical equipment: Medicare Part B covers medically necessary equipment, like a walker or wheelchair.

Putting It All Together

If you need a hip replacement, both Original Medicare and Medicare Advantage provide coverage. Your hip replacement needs may include an inpatient hospital stay, follow-up care, and equipment. Understanding your coverage and costs can help you prepare for your surgery. If you are in doubt, check with your doctor and insurance provider to see how coverage applies to your situation.