Does Medicare Cover Knee Replacement Surgery?
- Medicare covers knee replacement surgery when deemed medically necessary by your doctor. Learn about the costs and requirements for Medicare knee replacement coverage.
Yes, Medicare covers knee replacement surgery if it's deemed to be medically necessary.
Healthcare.gov defines the term medically necessary as "health care services or supplies needed to diagnose or treat an illness, injury, condition, disease or its symptoms and that meet accepted standards of medicine."
In other words, your doctor determines whether your knee replacement is medically necessary.
Knee replacement surgery is something that some Americans undergo as they age. According to 2015 statistics from The Journal of Bone and Joint Surgery, around 7 million Americans are living with a hip or knee replacement.
Costs for Knee Replacement Surgery
The costs for knee replacement surgery go beyond just the surgery itself. Also included are the initial diagnosis, referrals and recovery. Knee replacement surgery and associated procedures are covered under different parts of Medicare.
Medicare Part A
If you are admitted to the hospital for the knee replacement surgery or after, those costs would be covered under Medicare Part A. During recovery, if a stay at a skilled nursing facility is required, these costs also fall under Part A. Medications, clinical services and testing may be covered under Part A or under Part B depending on the specific service.
Medicare Part B
Initial screenings, treatment from your primary care doctor, referrals to an orthopedic specialist and other outpatient services are all covered under Medicare Part B.
The actual knee replacement surgery itself, if it is medically necessary, is typically performed as an outpatient procedure and would also be covered under Part B.
Medicare Part D
If you are prescribed medication to treat pain post-surgery or help ward off infection, those prescriptions would be covered under a Medicare Part D plan.
How Much Does a Knee Replacement Cost With Medicare?
The total cost of a knee replacement with Medicare is going to vary depending on your coverage. Remember that you have to meet your deductible first for services to be covered under Medicare. Your out-of-pocket costs are going to depend on your specific plan.
Check with your Medicare plan representative to find out more information about specific costs related to knee replacement surgery.
