Does Medicare Cover Knee Replacement Costs?

By: Agnus Smith
Published: Thursday, November 01 2018
Last Updated: 13 days ago

Knee replacement costs have gone up and down over the past few years, however, they are still expensive. This type of surgery is also one of the most general types of operations in today’s society. The average cost of knee replacement in the United States is around $16.5k to $33k depending on the location, procedure, and recovery scale. That is highly expensive for those that do not have that type of cost just lying in their pockets and to top that off, some people don’t even know if their insurance can help with the overall costs of a knee replacement surgery.

However, there are some types of insurance, such as Medicare, that do cover parts of a knee replacement surgery. In the following brief, you will learn what is involved with this surgery, the average coverage, and how Medicare Supplemental and Advantage plans fit into the picture.

What Is Involved In A Knee Replacement?

A knee replacement is a complex procedure that requires the skill and expertise of an orthopedic surgeon to remove the unhealthy parts of the bone and replace it with a knee implant. Essentially, they build a fake knee inside your leg in an effort to help you regain function. It is artificial, however, it functions as a normal knee joint would.

Most people that opt into undergoing knee replacement surgery do so in an effort to help with pain that is usually caused by osteoarthritis. Osteoarthritis is one of the most common chronic conditions for joints and affects around 27 million people in the US.

Original Medicare Coverage For Knee Replacement Surgery

Original Medicare coverage will largely be dependent on whether or not your doctor or physician deems your knee replacement surgery medically necessary. Luckily, this will likely be the case if you are experiencing any pain or difficulty.

Original Medicare is made up of two parts, Medicare Part A (inpatient hospital coverage) and Medicare Part B (outpatient medical insurance). Between the two parts, various aspects of your knee replacement procedure will be covered, including parts of your recovery process. While the majority of your costs will be covered under your benefits, you will still be responsible for out-of-pocket expenses related to your surgery, including your Part B deductible and 20% coinsurance of the remaining cost.

Medicare Supplement Plans Coverage For Knee Replacements

Medicare Supplement plans are not purchased to cover specific procedures, such as knee replacement surgery. Instead, these supplemental plans are used to help pay for any out-of-pocket costs that aren’t covered by your Original Medicare. So, if you’re looking to use your Medicare benefits for knee surgery, then you’re going to want to go through your Original Medical coverage, or Medicare Advantage (which will be touched on below).

However, as mentioned before, there will be out-of-pocket costs associated with your surgery even after your Part A and Part B benefits kick in. If you’re looking to cover those additional costs related to your procedure, the Medicare Supplement plan is a good option.

Medicare Advantage Coverage For Knee Replacements

If you aren’t familiar with Medicare Advantage (Part C), it’s a good idea to read up on it here. Essentially, Advantage plans are sold by Medicare-approved private insurance companies, and take the place of both Part A and Part B. Meaning, you will now be covered solely by your Advantage plan. Although, there are some added benefits to enrolling.

Medicare Advantage, just like your Original Medicare, will cover the costs of your knee replacement surgery if deemed medically necessary. However, depending on the plan you opt for, your out-of-pocket costs may be significantly lower. In addition to coverage directly related to the procedure, Advantage plans may also cover rehabilitation and prescription drugs for pain management (otherwise covered under a separate Medicare Part D plan).

Medicare is in the business of reducing medical costs for American seniors, so it makes sense that something as prevalent and important as knee replacement surgery is covered. It’s still important to talk to your doctor or Medicare representative so you are fully aware of what costs will be covered, and what costs you will be responsible for. You can talk to an experienced agent through FirstQuote Medicare today by entering your zip code and see what options are available in your area.