Medicare Part B covers hip replacement surgery, but you pay a share of the cost

Medicare Part B pays for hip replacement when a doctor determines it is medically necessary — usually because arthritis or injury has damaged the joint enough to limit your movement or cause chronic pain. Part B covers the surgeon's fee, the hospital facility, anesthesia, and post-operative care during your hospital stay. You do not pay the full cost: you owe a deductible, then a percentage of what Medicare approves, and the amounts vary depending on whether you have other insurance or have reached your out-of-pocket maximum for the year.

The surgery itself is typically done in a hospital outpatient surgery center or as an inpatient admission. If you stay overnight, Part A (hospital insurance) covers the bed and basic care; Part B covers the surgeon and anesthesiologist. Rehabilitation after surgery — physical therapy in a skilled nursing facility or at home — may also be covered, but the rules differ depending on whether you were admitted as an inpatient or treated as an outpatient.

Key Takeaways

  • Medicare Part B covers the surgeon, anesthesia, and facility costs for hip replacement when medically necessary, but you pay a deductible and coinsurance.
  • Your out-of-pocket cost in 2024 is a $240 Part B deductible, then 20% of the approved amount for the surgeon and facility.
  • If you stay overnight in the hospital, Part A also applies and you may owe a separate inpatient deductible.
  • Rehabilitation after surgery is covered only if you were admitted as an inpatient or meet specific criteria for skilled nursing care.
  • Medigap or Medicare Advantage plans can reduce or eliminate your out-of-pocket costs, but coverage rules differ by plan type.

What Medicare Part B actually pays for hip replacement

Part B covers the surgeon's fee, the anesthesiologist, the operating room, imaging (X-rays, MRI), lab work, and any implant or hardware used during the procedure. It also covers pre-operative visits to evaluate whether surgery is safe for you, and post-operative office visits during your recovery period — typically several weeks after discharge.

What Part B does not cover: cosmetic or elective procedures (if the surgery is done for reasons other than medical necessity), or any portion of the bill that exceeds what Medicare deems reasonable. If your surgeon charges more than Medicare's approved amount, you may owe the difference — unless you have a Medigap plan or your surgeon has agreed to accept Medicare's payment as full payment.

The approved amount varies by location and provider. Your surgeon's office can tell you what Medicare will pay for your specific procedure before you schedule surgery.

Your out-of-pocket costs under Original Medicare

Under Original Medicare (Part A and Part B), you pay:

  • A $240 Part B deductible per year (2024 amount; this changes annually)
  • 20% coinsurance on the surgeon's fee, anesthesia, and facility charges after the deductible is met
  • An inpatient hospital deductible if you are admitted overnight ($1,632 per stay in 2024)
  • Coinsurance for any hospital days beyond 60 days in a single stay

The total you owe depends on the approved cost of your surgery and your location. A hip replacement typically costs Medicare $30,000 to $50,000 in approved charges, which means your 20% coinsurance could range from $6,000 to $10,000 — plus deductibles. If you have already met your Part B deductible earlier in the year, you skip that $240.

These amounts are current for 2024. Medicare updates deductibles and coinsurance percentages each January, so confirm the current figures with your doctor's billing office or by calling Medicare directly at 1-800-MEDICARE.

How inpatient versus outpatient status affects your coverage

If your hip replacement is done in a hospital and you are admitted as an inpatient (you stay overnight), both Part A and Part B explore. You owe the Part A inpatient deductible, then coinsurance for days 61 and beyond. Part B covers the surgeon and anesthesiologist separately.

If the surgery is done in an outpatient surgery center or hospital outpatient department and you go home the same day, only Part B applies. You owe the Part B deductible and 20% coinsurance on the approved charges, but not the Part A inpatient deductible. Outpatient surgery typically costs you less out-of-pocket, but your surgeon and the facility decide whether your case requires an overnight stay.

This distinction matters for rehabilitation coverage too. If you were admitted as an inpatient and your doctor orders skilled nursing care afterward, Part A may cover up to 100 days in a skilled nursing facility (with coinsurance after day 20). If you had outpatient surgery, you generally do not may have access to for Part A-covered skilled nursing care, though Part B may cover home health services if your doctor orders them.

Rehabilitation and follow-up care coverage

Physical therapy after hip replacement is covered by Medicare, but the rules depend on your admission status. If you were an inpatient, Part A covers skilled nursing facility care for rehabilitation, and Part B covers outpatient physical therapy once you return home. If you had outpatient surgery, Part B covers outpatient physical therapy, and home health services are covered if your doctor orders them and you are homebound.

Your surgeon will typically order physical therapy to begin within days of surgery. The therapist will coordinate with Medicare to confirm coverage before you start. You pay 20% coinsurance for outpatient therapy visits after you meet your Part B deductible. Skilled nursing facility care has different cost-sharing: you pay nothing for days 1–20, then $194.50 per day (2024 amount) for days 21–100.

Coverage for therapy continues as long as your doctor documents that it is medically necessary and you are making progress. If you stop improving, Medicare may deny further sessions.

Medigap and Medicare Advantage coverage for hip replacement

If you have a Medigap (supplemental insurance) plan, it typically covers some or all of your Part B coinsurance and deductible, depending on which plan you hold. Plans G, F, and N cover the Part B deductible; most plans cover the 20% coinsurance. This means your out-of-pocket cost for hip replacement could be zero or very low.

If you have a Medicare Advantage plan (Part C), coverage works differently. Your plan must cover hip replacement if it is medically necessary, but you may owe a copay or coinsurance amount set by your plan — often $0 to $500 for surgery. Some Advantage plans cover the full cost; others require you to use in-network surgeons. Check your plan's summary of coverage or call the plan before scheduling surgery to learn your exact cost.

Neither Medigap nor Advantage plans are required to cover experimental or elective procedures. If your surgeon recommends surgery but Medicare does not deem it medically necessary, your supplemental plan will not cover it either.

Steps to take before scheduling hip replacement surgery

Before you book surgery, contact your surgeon's billing office and ask them to submit a pre-authorization request to Medicare. This is not required, but it confirms that Medicare will cover the procedure and gives you an estimate of your out-of-pocket cost. The office can also tell you whether your surgeon accepts Medicare's approved amount as full payment.

If you have Medigap or Medicare Advantage, call your supplemental plan and ask what you will owe. Provide them with the procedure code (typically 27130 for primary hip replacement) and your surgeon's name so they can give you an accurate estimate.

Ask your surgeon's office whether the surgery will be inpatient or outpatient, because this affects your Part A and Part B costs. If you are unsure whether surgery is medically necessary in Medicare's view, ask your doctor to explain the clinical reason — Medicare denies some hip replacements if the damage is mild or if non-surgical treatment has not been tried first.

Frequently Asked Questions

Will Medicare cover hip replacement if I have arthritis but no pain?

Medicare requires that the damage be severe enough to limit your function or cause chronic pain. Arthritis alone, without symptoms, is usually not enough. Your doctor must document that conservative treatment (physical therapy, medication, injections) has not worked or is not appropriate before Medicare will cover surgery.

What if my surgeon charges more than Medicare approves?

If your surgeon is a Medicare-participating provider, they must accept Medicare's approved amount as full payment and cannot bill you the difference. If they are non-participating, you may owe the difference. Ask your surgeon's office whether they participate in Medicare before you schedule.

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

Yes, if both hips are damaged and your doctor determines surgery is medically necessary on both sides. You would owe separate deductibles and coinsurance for each surgery, unless you have Medigap or Advantage coverage that limits your costs.

Is physical therapy after surgery covered if I do it at home?

Home physical therapy is covered by Part B if your doctor orders it and you are homebound (unable to leave home without help). If you can travel to an outpatient clinic, Medicare covers therapy there instead. You pay 20% coinsurance for either setting after you meet your Part B deductible.

What happens if Medicare denies my hip replacement as not medically necessary?

You have the right to appeal. Your surgeon can submit additional documentation of your pain, imaging results, and failed conservative treatments. If Medicare still denies coverage, you can request an independent review. During the appeal, you are not responsible for the bill unless you signed a form acknowledging the procedure might not be covered.