Medicare covers hip replacement surgery, but your costs depend on which type of Medicare you have and whether you meet certain conditions

If your doctor recommends hip surgery, Medicare Part B will cover the procedure itself — the surgeon's fee, the operating room, anesthesia, and hospital stay. You will pay a portion of these costs through your deductible and coinsurance. The amount you owe depends on whether you have Original Medicare (Parts A and B) or a Medicare Advantage plan, and whether the surgery happens in a hospital or outpatient surgery center.

Hip surgery includes several types: total hip replacement (also called arthroplasty), partial hip replacement, and hip repair. Medicare covers all of these when a doctor determines they are medically necessary. The key word is "medically necessary" — Medicare will not cover the surgery if it is elective or cosmetic, or if your condition can be treated without surgery.

Key Takeaways

  • Original Medicare Part B covers hip replacement surgery after you meet your annual deductible, and you pay 20 percent coinsurance for the procedure.
  • If you have a Medicare Advantage plan, your out-of-pocket costs may be lower, but you must use in-network surgeons and hospitals or pay more.
  • Medicare Part A covers your hospital stay, including room, meals, and nursing care, but only after you pay the Part A deductible.
  • You are responsible for any charges from your surgeon or hospital that are not covered by Medicare, so ask about costs before surgery.
  • Physical therapy after surgery is covered by Medicare Part B, which helps you recover and regain mobility.

How Original Medicare Covers Hip Surgery Costs

With Original Medicare (Parts A and B), the hospital stay is covered under Part A and the surgery itself under Part B. For the hospital stay, you pay a one-time deductible (the amount changes each year) and then nothing more for up to 60 days. After 60 days, you pay a daily coinsurance amount, though most hip surgeries do not require a stay longer than a few days.

For the surgery and related care under Part B, you pay your annual deductible first (also changes yearly), then Medicare pays 80 percent of the approved amount and you pay 20 percent. This 20 percent coinsurance continues for any follow-up visits, imaging, or therapy related to your hip surgery. If your surgeon or hospital charges more than Medicare's approved amount, you may owe the difference — this is called "balance billing," and it is your responsibility to ask about it before surgery.

Original Medicare does not have an out-of-pocket maximum, meaning your costs can add up if you need ongoing care. Many people with Original Medicare buy a Medigap (supplemental insurance) plan to cover the deductible and coinsurance, which can reduce what you pay.

Medicare Advantage Plans and Hip Surgery

If you have a Medicare Advantage plan (Part C), your coverage works differently. These plans are run by private insurance companies and must cover everything Original Medicare covers, but they set their own rules about deductibles, copays, and coinsurance. Some plans have low or zero deductibles for surgery, while others charge a copay per visit or a percentage of the cost.

The trade-off is that Medicare Advantage plans have networks. You must use in-network surgeons and hospitals, or you will pay much more — sometimes the full cost. Before scheduling surgery, call your plan and confirm that your surgeon and the hospital are in-network. Ask your plan what your total out-of-pocket cost will be, including any copays, coinsurance, and deductibles.

Medicare Advantage plans do have an out-of-pocket maximum, which means once you reach a certain amount in a year, the plan pays 100 percent of covered costs for the rest of that year. This can protect you from very high bills if you need major surgery.

What Medicare Does Not Cover for Hip Surgery

Medicare does not cover certain costs related to hip surgery. You will pay out of pocket for any charges above Medicare's approved amount if your provider does not accept Medicare assignment. You also pay for any services or supplies that Medicare considers experimental or not medically necessary.

Some hospitals or surgeons may charge facility fees or other costs that are not part of the standard surgical package. Ask your hospital for an itemized estimate before surgery so you know what Medicare will cover and what you will owe. If you are having surgery at an outpatient center rather than a hospital, the rules are slightly different — ask whether the center is Medicare-approved and what your costs will be.

Prescription medications you take at home after surgery are covered by Medicare Part D (prescription drug coverage) if you have it, but you pay your Part D copay or coinsurance. Any equipment you need at home, such as a walker or crutches, may be covered as durable medical equipment under Part B, but you will pay 20 percent coinsurance after your deductible.

Physical Therapy and Recovery Costs

Medicare Part B covers physical therapy after hip surgery, which is essential for regaining strength and mobility. You pay your Part B coinsurance (20 percent) for each therapy visit after you meet your deductible. Medicare does not limit the number of therapy sessions, but your doctor must order them as medically necessary, and your therapist must accept Medicare.

If you need therapy in a skilled nursing facility (a facility that provides nursing care and rehabilitation), Medicare Part A may cover this for up to 100 days if you meet certain conditions. You pay nothing for the first 20 days, then a daily coinsurance amount for days 21 through 100. After 100 days, you pay the full cost.

Questions to Ask Your Doctor and Hospital Before Surgery

Before you schedule hip surgery, ask your doctor whether Medicare will cover the procedure. Your doctor should confirm that the surgery is medically necessary and that your condition cannot be treated another way. Ask whether the surgery will happen in a hospital or outpatient center, because this affects which Medicare parts cover it and what you pay.

Contact your hospital's billing department and ask for an estimate of what Medicare will pay and what you will owe. Ask specifically whether the surgeon and facility are Medicare-approved and whether they accept Medicare assignment (meaning they accept Medicare's approved amount as full payment). If you have a Medicare Advantage plan, call your plan before surgery to confirm in-network status and get a cost estimate.

Ask your doctor how long your hospital stay will be and whether you will need skilled nursing care or physical therapy afterward. These details affect your total costs and help you plan for recovery.

When to Contact Medicare or Your Plan

If you are unsure whether your surgery is covered, call Medicare at 1-800-MEDICARE (1-800-633-4227) before you schedule. You can also visit Medicare.gov and use the "Coverage" tool to search for hip surgery or hip replacement. If you have a Medicare Advantage plan, call your plan's customer service number (on your insurance card) to ask about coverage and costs.

If you receive a bill after surgery that seems wrong, do not ignore it. Contact your hospital's billing department or your Medicare plan to ask why you were charged. You have the right to see an itemized bill and to ask for an explanation of any charges.

Frequently Asked Questions

Will Medicare cover hip surgery if I am under 65?

Medicare covers hip surgery for people under 65 only if you have been receiving Social Security disability benefits for at least 24 months, or if you have end-stage renal disease or ALS. If you are under 65 and do not meet these conditions, you would need to check your employer health plan or other coverage.

Do I have to pay anything if I have a Medigap plan?

A Medigap plan covers most or all of your Medicare deductible and coinsurance, so your out-of-pocket costs are usually much lower. However, you still pay your Medigap premium each month. The exact amount you owe depends on which Medigap plan you have.

What happens if my surgeon does not accept Medicare?

If your surgeon does not accept Medicare assignment, you may have to pay the full bill upfront and then file a claim yourself, or you may owe the difference between what Medicare pays and what the surgeon charges. Always confirm that your surgeon accepts Medicare before scheduling.

Is hip replacement surgery considered elective?

Hip replacement is covered by Medicare when it is medically necessary — meaning your hip damage is severe enough that surgery is the appropriate treatment. If your doctor recommends it to relieve pain and restore function, Medicare will likely cover it. If you want surgery purely for cosmetic reasons or before your condition warrants it, Medicare will not cover it.

Will Medicare cover a second hip replacement on the other side?

Yes, Medicare covers hip replacement on both sides if both hips need surgery. You would pay your deductible and coinsurance for each surgery. If the surgeries happen in the same calendar year, you only pay one Part B deductible, but you pay coinsurance for both procedures.