Does Medicare cover hip replacements?

If your doctor has recommended hip replacement surgery and you are wondering how to pay for it, there is a possibility that Medicare can help. If you are age 65 or over or you have a disability, make sure you are enrolled in Original Medicare, preferably Part A and Part B. Medicare Part A usually covers inpatient hospital stays, which you would require for a complex surgical procedure like a hip replacement. Medicare Part B usually covers the fees associated with your doctor’s services. In the case of hip replacement, this would be the surgical procedure itself, pre-surgery exams and consultations, and post-surgery aftercare.

Even if you are enrolled in Medicare, the federal government’s healthcare program will not automatically cover your hip replacement surgery. Joint replacement procedures are normally covered only for people who have not seen conditional improvements from other, less expensive treatments. Your doctor will have to provide Medicare with detailed records indicating that a hip replacement is “medically necessary” in order for Medicare to assist you with coverage.

If you qualify for assistance, you will probably still have to pay your Part A and/or your Part B deductible before Medicare will begin paying for your hip replacement procedure. You may also have co-payments or co-insurance. Medicare Part B commonly pays 80% of a the Medicare-approved amount for doctor or outpatient services. That means that you will be responsible for paying the remaining 20%. The Medicare-approved amount is a pre-set amount that Medicare has agreed to pay your doctor for his or her services. Note that your doctor’s usual service fees may be higher than the Medicare-approved amount. That would mean that you will have to pay the difference out of pocket.

If Medicare declines

If Medicare declines to assist you with your hip replacement surgery under Part A or Part B, you should consider additional insurance coverage. Medicare Part C plans, or Medicare Advantage plans, are required to offer the same coverage as Part A and Part B plans. However, they often have additional benefits that can help with surgery costs. You should also consider Medicare Supplemental Insurance, often called Medigap. Medigap plans are provided by third-party insurance carriers rather than by the federal government. These plans may be able to assist you in paying high deductibles, co-payments, or co-insurance related to your hip replacement procedure.

As always, you should consult with your doctor or healthcare provider before scheduling any procedures. Be sure that your doctor and surgical facility are both Medicare certified. You may contact Medicare directly at 1-800-633-4227 if you have additional questions.

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