An estimated 2.5 million Americans have undergone total hip replacements. Conditions such as osteoarthritis and rheumatoid arthritis can cause the hip joint to wear down so much that a hip replacement may be the only course of action to improve your mobility.
The total cost of hip replacement surgery can be staggering if you don’t have help from insurance. A total hip replacement costs anywhere from $32,000 to $45,000. The total cost usually includes everything from the surgeon’s initial evaluation to post-operation hospital care.
If you’re one of the millions of Americans who need hip replacements, you may wonder, “Does Medicare cover hip replacements?” Yes, but you have to meet certain eligibility requirements, and you may still have some out-of-pocket costs even with Original Medicare.
How Much Does Medicare Pay for Hip Replacement Surgery?
Original Medicare (Parts A and B) will help cover the cost of hip replacement surgery if your doctor determines it’s medically necessary because other treatments have failed.
Medicare Hip Replacement Costs With Medicare Part A
Medicare Part A is hospital insurance. Part A coverage helps pay for a semi-private room, meals and nursing care during your stay. Medicare Part A will only cover a private room if your doctor says it’s medically necessary or it’s the only room available.
If you need skilled nursing care after your surgery, Part A helps cover the first 100 days of care including physical therapy. The Medicare Part A deductible can apply, and you may be responsible for copays or coinsurance.
Part B Coverage for Hip Replacement Surgery
Medicare Part B will help cover medical expenses such as doctor’s fees for the initial evaluation and post-op visits, the surgery if it takes place in an outpatient surgical facility, and outpatient physical therapy.
You may be responsible for paying the Part B deductible, which is $185 in 2019, and 20 percent of the Medicare-approved costs. Medicare Part B may also cover your post-operative durable medical equipment (DME) such as a cane or in-home grab bars.
Medicare Part D Coverage
Original Medicare does not cover post-op prescription drugs, but Medicare Part D does. Your doctor may prescribe blood thinners to prevent clotting or painkillers to take during your recovery. You can use Medicare Part D or private health insurance plans to cover prescription drugs.
What Medicare Advantage and Medicare Supplements Cover
Private insurance plans offer Medicare Advantage (MA) plans, and they are a great way to get all of the Part A and Part B benefits along with some unexpected offerings such as meal delivery, non-emergency transportation, vision and dental insurance.
Certain MA plans even cover prescription drugs! You will pay a monthly premium with MA plans, but some are as low as $0. Coverage varies depending on your location and the plans available, so look for a qualified professional to help you sort through the plans in your area and find the right one.
Medicare Supplement (Medigap) plans pick up where Original Medicare leaves off. Like MA plans, private insurance companies offer Medigap plans. The difference is that Medigap Plans only cover your financial responsibilities such as coinsurance and deductibles. You cannot have both a Medicare Supplement and a Medicare Advantage plan at the same time, so it’s important to find out what’s best for you.
Why You Might Need a Hip Replacement
Several conditions can cause the hip to deteriorate to the point of needing surgery including:
- Rheumatoid Arthritis
- Avascular Necrosis
- Bone Tumors
- Hip Injuries
Hip replacement surgery can restore the hip joint and a full range of motion. The type of replacement you receive depends on the doctor’s recommendation and your general health.
The surgery may use a cemented or uncemented prosthesis to connect the replacement parts to the healthy bone after the unhealthy cartilage is removed. The entire recovery process can take three to six months.
Medicare Hip Replacement Scenario
To better understand how everything works together, let’s take the real-world example of a 75-year-old man who has osteoarthritis.
He’s been working with his doctor to manage his symptoms, and things have been going well. One day, the man takes a nasty fall and breaks his hip. This man’s Medicare hip replacement process involves several steps:
- He doesn’t go to the hospital right away because the bruising around his hip looks like one of his routine injuries. The man makes another doctor’s appointment, and his doctor takes X-rays and determines the man will need a hip replacement.
- His doctor will determine if the man is healthy enough for surgery, and then the doctor refers the man to an orthopedic surgeon. Until this point, everything falls under Medicare Part B.
- The man decides to have his surgery in an outpatient facility. He’s responsible for his deductible if he hasn’t met it, or the out-of-pocket maximum for his plan.
- The surgery is successful, so he has physical therapy appointments so he can recover as quickly as possible. The man has a Medicare Advantage Prescription Drug plan, so he collects his blood thinners and painkillers for only a small copayment at the pharmacy.
- Along with prescription drugs, the man’s surgeon prescribes a cane and grab bars to help the man perform daily tasks. The man’s MA plan also covers those items, because his doctor determined they are medically necessary.
Contact Us Today
A comprehensive Medicare plan can help cover the cost of hip replacement surgery. If you need help finding coverage, we can help! Call us at 833-438-3676 or contact us here today.
This post was originally published on May 15, 2019, and updated on July 5, 2019.