Medicare covers hip replacement and hip repair surgery, but your out-of-pocket costs depend on which part of Medicare you have and whether you meet certain conditions.

If you have Original Medicare (Part A and Part B), hip surgery is covered as an inpatient hospital procedure. Part A covers the hospital stay, surgeon fees, anesthesia, and most related care. Part B covers your surgeon's services. You will pay a Part A deductible (which changes yearly) for the hospital stay, then coinsurance for each day after day 60. If you have a Medigap or Medicare Advantage plan, your costs may be lower, but coverage rules differ between plans.

Hip surgery is considered medically necessary by Medicare when a doctor documents that you have a hip fracture, severe arthritis, or another condition that limits your ability to walk or function. Medicare does not cover hip surgery for cosmetic reasons or if your doctor believes physical therapy or other non-surgical treatment would work as well. The surgery must be performed at a hospital or an approved surgical center.

Key Takeaways

  • Original Medicare Part A covers the hospital stay and facility costs for hip surgery; Part B covers the surgeon and anesthesiologist.
  • You pay a Part A deductible upfront, then coinsurance for days 61 and beyond if your stay extends that long.
  • Medicare requires a doctor to document that surgery is medically necessary, not just a preference for pain relief.
  • Medicare Advantage and Medigap plans have different cost structures and may cover some out-of-pocket expenses that Original Medicare does not.
  • Pre-surgery approval from Medicare is not required, but your doctor should confirm your coverage before scheduling.

How Original Medicare Covers Hip Surgery Costs

Under Original Medicare, hip surgery is covered as an inpatient hospital procedure, which means you stay overnight in the hospital. Part A covers the hospital facility, bed, meals, nursing care, operating room, and most supplies. Part B covers the surgeon's fee, the anesthesiologist, and the radiologist who reads X-rays. Both parts work together to pay for the full procedure.

Your out-of-pocket cost begins with the Part A deductible, a single amount you pay once per benefit period (October 1 to September 30). After you meet the deductible, Medicare pays 100 percent of covered costs for days 1 through 60. On days 61 and beyond, you pay coinsurance—a daily amount set by Medicare—for each day you remain in the hospital. Most hip surgeries result in a hospital stay of 2 to 4 days, so many people pay only the deductible and no coinsurance.

After you leave the hospital, if you move to a skilled nursing facility for rehabilitation, Part A covers up to 100 days. You pay nothing for days 1 through 20, and coinsurance for days 21 through 100. Physical therapy in an outpatient setting is covered by Part B after you pay your Part B deductible and 20 percent coinsurance for each visit.

Medicare Advantage Plans and Hip Surgery Coverage

If you have a Medicare Advantage plan (Part C), your hip surgery coverage works differently. These plans are run by private insurance companies and must cover everything Original Medicare covers, but they set their own rules for how much you pay out of pocket. Some plans charge a copay for the hospital stay; others charge coinsurance. Some plans require you to use doctors and hospitals in their network, and some require prior authorization before surgery.

Contact your Medicare Advantage plan before scheduling hip surgery to learn your exact costs and whether your surgeon and hospital are in-network. Out-of-pocket costs for hip surgery under Medicare Advantage vary widely—some plans have an annual out-of-pocket maximum that caps your total costs, while others do not. Knowing this ahead of time helps you budget and avoid surprise bills.

Medigap Plans and Hip Surgery Costs

Medigap (supplemental insurance) works alongside Original Medicare and helps pay some of the costs that Medicare does not cover. If you have Medigap, it pays part or all of your Part A deductible, coinsurance, and copays, depending on which Medigap plan you own. For example, a Medigap Plan G covers your Part A deductible, so you would pay nothing upfront for the hospital stay. A Medigap Plan N covers coinsurance but not the deductible.

Medigap does not change what Medicare covers—it only reduces what you pay out of pocket. You still use Original Medicare as your primary insurance, and Medigap pays secondary. If you have both Original Medicare and Medigap, you will have lower out-of-pocket costs for hip surgery than if you have Original Medicare alone.

What Medicare Requires Before Hip Surgery

Medicare does not require you to get pre-approval before hip surgery, but your doctor must document that the surgery is medically necessary. This means your doctor writes in your medical record that you have a condition—such as a hip fracture, severe osteoarthritis, or avascular necrosis—that causes pain or loss of function, and that surgery is the appropriate treatment. Medicare reviews this documentation if a question arises, but you do not need to submit it yourself before the procedure.

If your doctor recommends hip surgery and you are unsure whether Medicare will cover it, ask your doctor's office to contact Medicare on your behalf. They can confirm coverage in advance. This step is optional but can prevent confusion and give you peace of mind before surgery day.

Hospital Stays and Rehabilitation After Hip Surgery

Most hip surgery patients stay in the hospital for 2 to 4 days. During this time, Part A covers all facility costs. After discharge, many people move to a skilled nursing facility (SNF) for rehabilitation and physical therapy. Part A covers up to 100 days in an SNF per benefit period if you meet Medicare's requirements: you must have been admitted to a hospital for at least 3 days, and you must be admitted to the SNF within 30 days of hospital discharge.

In the SNF, you pay nothing for days 1 through 20. On days 21 through 100, you pay a daily coinsurance amount set by Medicare. If you have Medigap, it may cover this coinsurance. If you have a Medicare Advantage plan, check your plan documents for SNF coverage rules, as they vary.

Outpatient physical therapy after you return home is covered by Part B. You pay your Part B deductible (if you have not met it yet) and 20 percent coinsurance for each therapy visit. There is no limit on the number of therapy visits Medicare will cover, as long as your doctor orders them and they are medically necessary.

Costs You May Not Expect

Some costs related to hip surgery are not covered by Medicare. If your surgeon orders imaging, blood work, or other tests before surgery, these are usually covered by Part B (with your deductible and coinsurance), but confirm this with your doctor's office. Prescription pain medications after surgery are covered by Part D (prescription drug coverage) if you have it; if you do not, you pay the full pharmacy price.

If you stay in the hospital longer than expected due to complications, your coinsurance costs increase, but Part A still covers the care. If you choose a surgeon or hospital outside the Medicare network (which is rare, since most hospitals accept Medicare), you may face higher bills. Always confirm that your surgeon and hospital accept Medicare assignment before surgery.

Frequently Asked Questions

Do I need Medicare approval before hip surgery?

No, Medicare does not require pre-approval. Your doctor must document that surgery is medically necessary, but you do not need to submit paperwork to Medicare first. If you want confirmation in advance, ask your doctor's office to contact Medicare.

What if I have both Medicare and a Medigap plan?

Medigap pays secondary to Medicare and covers some of the costs Medicare does not pay, such as deductibles and coinsurance. Your out-of-pocket costs will be lower than with Original Medicare alone. The exact amount depends on which Medigap plan you have.

How much will I pay out of pocket for hip surgery?

With Original Medicare alone, you pay the Part A deductible (typically $1,600 or more, though this changes yearly) plus any coinsurance if your hospital stay exceeds 60 days. Most hip surgeries result in a 2- to 4-day stay, so you pay mainly the deductible. Costs are lower with Medigap or a Medicare Advantage plan.

Does Medicare cover hip surgery in an outpatient surgery center?

Yes, if the surgery center is Medicare-approved and the procedure qualifies as outpatient. Outpatient hip surgery is less common than inpatient, but when it occurs, Part B covers the surgeon and anesthesia. You pay your Part B deductible and 20 percent coinsurance.

What happens if I need a second hip surgery?

Medicare covers a second hip surgery the same way it covers the first. You pay the Part A deductible again if the surgery occurs in a new benefit period (after September 30). If it occurs in the same benefit period, you do not pay another deductible.