Does Medicare Cover Knee Replacement Surgery?

Vincent Thrasher

Founder at - over65 insurance options

Vincent Thrasher, the pioneering founder of Over65InsuranceOptions, has an impressive 20-year tenure in the insurance industry. His in-depth expertise spans the entire spectrum of senior...Read more

Knee replacement surgery can be a life-changing procedure for those suffering from chronic pain and limited mobility. However, the cost of the surgery can be a major concern for many patients. That’s where Medicare comes in: it’s a government-funded healthcare program that provides coverage for certain medical procedures, including knee replacement surgery. But does Medicare cover the full cost of the surgery? Let’s take a closer look at what Medicare does and doesn’t cover when it comes to knee replacement surgery.

Does Medicare Cover Knee Replacement Surgery?

If you are experiencing severe knee pain and mobility issues, you may be considering knee replacement surgery. However, the cost of the procedure can be a significant concern. If you are enrolled in Medicare, you may be wondering if your insurance will cover the cost of knee replacement surgery. In this article, we will explore whether Medicare covers knee replacement surgery and what you need to know before undergoing the procedure.

Medicare Coverage for Knee Replacement Surgery

Medicare does cover knee replacement surgery, but the coverage may vary depending on your specific situation and the type of Medicare plan you have. Generally, Medicare Part A covers the hospital stay, while Medicare Part B covers the doctor’s fees and other medical services. However, you will still be responsible for paying deductibles, copays, and coinsurance.

It’s important to note that not all knee replacement procedures are the same, and some may be considered experimental or not medically necessary. In those cases, Medicare may not cover the procedure. Your doctor will be able to provide you with more information about whether your knee replacement surgery is covered by Medicare.

Medicare Part A Coverage for Knee Replacement Surgery

Medicare Part A covers the inpatient hospital stay for knee replacement surgery. This includes the cost of the hospital room, meals, and general nursing care. However, you will be responsible for paying the Part A deductible, which is $1,484 in 2021.

If you need to stay in the hospital for an extended period, you may also be responsible for paying a daily coinsurance amount. This amount varies depending on how long you stay in the hospital.

Medicare Part B Coverage for Knee Replacement Surgery

Medicare Part B covers the doctor’s fees and other medical services related to knee replacement surgery. This includes the cost of the surgeon, anesthesiologist, and any necessary medical equipment. However, you will be responsible for paying the Part B deductible, which is $203 in 2021.

After you meet your deductible, you will still be responsible for paying 20% of the Medicare-approved amount for the doctor’s fees and other medical services. If your doctor charges more than the Medicare-approved amount, you may be responsible for paying the difference.

Benefits of Knee Replacement Surgery

Knee replacement surgery can provide many benefits for those suffering from severe knee pain and mobility issues. Some of the benefits of knee replacement surgery include:

• Reduced knee pain


• Improved mobility and range of motion


• Improved quality of life


• Ability to participate in physical activities without pain


• Reduced risk of falls and other injuries

If you are considering knee replacement surgery, it’s important to talk to your doctor about the potential benefits and risks of the procedure.

Knee Replacement Surgery vs. Other Treatments

Knee replacement surgery is not the only treatment option for those suffering from knee pain and mobility issues. Other treatment options include:

• Physical therapy


• Medications


• Injections


• Weight loss


• Alternative therapies, such as acupuncture

Your doctor will be able to help you determine which treatment option is best for you based on your specific situation and medical history.

Final Thoughts

If you are enrolled in Medicare and considering knee replacement surgery, it’s important to understand the coverage options and potential costs associated with the procedure. While Medicare does cover knee replacement surgery, you will still be responsible for paying deductibles, copays, and coinsurance. Talk to your doctor about whether knee replacement surgery is the best treatment option for you and what your out-of-pocket costs may be.

Frequently Asked Questions

Does Medicare Cover Knee Replacement Surgery?

Yes, Medicare does cover knee replacement surgery if it is considered medically necessary. Medicare Part A covers the cost of the hospital stay, while Medicare Part B covers the cost of the surgery itself, as well as any necessary equipment and supplies. However, there may be out-of-pocket costs associated with knee replacement surgery, such as deductibles and copayments.

It is important to note that Medicare will only cover knee replacement surgery if certain criteria are met. The surgery must be deemed medically necessary by a doctor, and other treatments, such as physical therapy or medication, must have been tried and failed. Additionally, the surgery must be performed by a Medicare-approved provider.

What is the eligibility criteria for Medicare Coverage of Knee Replacement Surgery?

To be eligible for Medicare coverage of knee replacement surgery, you must first be enrolled in Medicare Part A and Part B. Additionally, the surgery must be deemed medically necessary by a doctor, and other treatments, such as physical therapy or medication, must have been tried and failed. The surgery must be performed by a Medicare-approved provider.

It is important to note that while Medicare will cover the cost of knee replacement surgery, there may be out-of-pocket costs associated with the procedure, such as deductibles and copayments. It is important to talk to your doctor and Medicare provider to understand your specific coverage and any potential costs.

Does Medicare cover inpatient rehabilitation after knee replacement surgery?

Yes, Medicare Part A covers inpatient rehabilitation after knee replacement surgery. If your doctor deems rehabilitation necessary after the surgery, Medicare will cover the cost of up to 100 days in a skilled nursing facility. However, there may be out-of-pocket costs associated with inpatient rehabilitation, such as deductibles and copayments.

It is important to note that Medicare will only cover inpatient rehabilitation if certain criteria are met. The rehabilitation must be deemed medically necessary by a doctor, and the patient must have spent at least three consecutive days as an inpatient in the hospital prior to being transferred to the rehabilitation facility.

Does Medicare cover outpatient physical therapy after knee replacement surgery?

Yes, Medicare Part B covers outpatient physical therapy after knee replacement surgery. If your doctor deems physical therapy necessary after the surgery, Medicare will cover the cost of therapy sessions with a Medicare-approved provider. However, there may be out-of-pocket costs associated with outpatient physical therapy, such as deductibles and copayments.

It is important to note that Medicare will only cover outpatient physical therapy if certain criteria are met. The therapy must be deemed medically necessary by a doctor, and the patient must have a plan of care established by their doctor outlining the specific therapy services needed.

Can I choose my own provider for knee replacement surgery under Medicare?

Yes, you can choose your own provider for knee replacement surgery under Medicare, as long as they are a Medicare-approved provider. It is important to do research and talk to your doctor to find a provider that is right for you and meets Medicare’s requirements.

It is also important to note that Medicare may not cover the full cost of knee replacement surgery from all providers. It is important to talk to your doctor and Medicare provider to understand your specific coverage and any potential costs.

Does Medicare Cover Knee Replacement Surgery?

In conclusion, Medicare does cover knee replacement surgery for eligible patients. However, it is important to note that there may be certain restrictions and limitations based on individual circumstances. It is recommended to consult with a healthcare provider or Medicare representative to fully understand the coverage and any potential out-of-pocket costs.

Despite the potential limitations, it is reassuring to know that Medicare can provide coverage for a surgery that can greatly improve quality of life for those suffering from knee pain and mobility issues. With proper research and guidance, eligible patients can take advantage of this coverage and take steps towards a healthier and pain-free future.

Overall, the availability of Medicare coverage for knee replacement surgery highlights the importance of accessible healthcare options for all individuals. By utilizing these resources and staying informed, individuals can make informed decisions about their healthcare and take steps towards a better quality of life.

Vincent ThrasherFounder at - over65 insurance options

Vincent Thrasher, the pioneering founder of Over65InsuranceOptions, has an impressive 20-year tenure in the insurance industry. His in-depth expertise spans the entire spectrum of senior insurance, encompassing Medicare, Medigap, long-term care insurance, life insurance, and dental, vision, and hearing insurance. Vincent's unwavering passion for guiding seniors through the intricate insurance landscape and crafting customized solutions to address their individual needs has earned Over65InsuranceOptions an esteemed reputation as a dependable ally for seniors nationwide.

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