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Medicare and Knee Replacement

Knee replacement is one of the commonest in-patient surgeries that is performed to provide relief from joint pains and improve the quality of the patient’s life. It is also an expensive procedure, which requires patients to bear huge costs related to hospitalization, surgery, and medications.

Patients also have to bear expenses for home healthcare when they continue to need round the clock care even after discharge from the hospital.

If you or your relative has been advised to undergo knee replacement surgery, read this article carefully to understand whether the costs would be covered by your Medicare policy. This would give you an idea of the extent of the costs that you will have to bear out of pockets.

knee replacement

Will Medicare help pay for a knee replacement?

The cost of a knee replacement can be anywhere between $15000 to $30000. It is because of the high costs that the concerned authorities in the United States have implemented a new system for the Medicare coverage for knee replacement procedure and other similar in-patient surgeries such as hip replacement. 

The changes have been designed to lower expenses and increase the success rate of the procedures. Some surgeons voiced their concerns about the new procedure eventually leading them to discourage patients from opting for the surgery due to their lower chances of success and recovery.

Hence, the new program was designed to emphasize quality over quantity for doctors and hospitals that perform knee replacements. The emphasis is particularly on reducing the post-surgical complications that can prevent speedy recovery of the patients while worsening the burden of expenses.

The changes in the program would be invisible to beneficiaries seeking Medicare coverage at the start. However, due to the cost and quality targets related to the hospital performance recommend in the new program, the future knee replacement seekers might find it difficult to receive Medicare reimbursement.

Medicare coverage for Parts A and B

At present, Original Medicare Parts A and B pay for certain costs of knee replacement surgery provided the procedure is deemed medically necessary by the doctor. Part A would cover the expense of the hospital stay while Part B would cover out-patient and recovery services mandated by the physician. 

Patients would have to pay Part B deductible and 20% of the co-insurance fees.

Medicare Part C (also called Medicare Advantage) would provide the same coverage as Medicare Part A and B and additional coverage for certain services. If you anticipate knee replacement surgery in the future, can explore Part C plans for better coverage.

Antibiotics, anticoagulants, and painkillers prescribed by the doctor following knee surgery would be covered by Medicare Part D’s prescription drug program or Medicare Advantage Prescription Drug policy.

Patients should check the costs of the procedure and the extensive aftercare that involves pain medications and physical therapy. 


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