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

Medicare Part B pays for hip replacement when your doctor says it is medically necessary — usually because arthritis or injury has damaged your hip joint enough to limit your movement or cause chronic pain. You will pay a deductible, then Medicare pays 80% of the approved amount for the surgery and related hospital care. You are responsible for the remaining 20%, plus any costs above what Medicare considers reasonable.

The total out-of-pocket cost depends on whether the surgery happens in a hospital inpatient setting (covered under Part A) or an outpatient surgery center (covered under Part B). Hospital inpatient stays have different cost rules than outpatient procedures, so the breakdown of what you owe differs. Your surgeon's office can tell you which setting they use and what your share will be based on your specific Medicare plan.

Key Takeaways

  • Medicare Part B covers hip replacement surgery when medically necessary, and you pay 20% of the approved cost after meeting your deductible.
  • If the surgery is done in a hospital as an inpatient stay, Part A covers it instead, and your costs follow the inpatient hospital cost structure.
  • You are responsible for any charges above Medicare's approved amount if your surgeon does not accept Medicare assignment.
  • Physical therapy after surgery is covered by Medicare Part B when ordered by your doctor, but you pay 20% of that cost as well.
  • Supplemental insurance (Medigap) or a Medicare Advantage plan can reduce your out-of-pocket costs for the surgery and recovery.

How Medicare decides whether to cover your hip replacement

Your doctor must document that hip replacement is medically necessary for your condition. This usually means X-rays or imaging show significant joint damage, you have tried other treatments (like physical therapy or injections) without enough relief, and the surgery will meaningfully improve your function or reduce pain. Medicare does not cover hip replacement for cosmetic reasons or minor wear and tear.

Your surgeon will submit the medical records to Medicare before the surgery. Medicare reviews them and sends an approval letter if the procedure meets their criteria. This pre-approval step protects you — if Medicare denies the request, you will know before you have surgery and can discuss other options with your doctor. If you disagree with a denial, you have the right to appeal.

What you pay: inpatient versus outpatient surgery

If your hip replacement happens in a hospital and you stay overnight, Medicare Part A covers it. You pay the Part A inpatient deductible (the amount changes each year), then Medicare covers all approved costs for the hospital stay. You do not pay a percentage for the hospital portion.

If the surgery is done at an outpatient surgery center or hospital outpatient department, Medicare Part B covers it. You pay your Part B deductible (if you have not met it yet), then you pay 20% of the approved amount for the surgeon's fee, anesthesia, and facility charges. Ask your surgeon's office ahead of time which setting they use, because this affects your total cost.

Some surgeons are in-network with Medicare (they accept assignment), meaning they agree to accept Medicare's approved amount as full payment. Others are out-of-network and can bill you for the difference between their charge and Medicare's approved amount. Confirm your surgeon's status before scheduling.

Costs for pre-surgery tests and post-surgery care

Tests before surgery — such as blood work, EKGs, or imaging — are covered by Medicare Part B if your doctor orders them as part of preparing for the procedure. You pay 20% of the approved cost after your deductible. These costs add up, so ask your surgeon's office for an estimate.

Physical therapy after surgery is covered by Medicare Part B when your doctor orders it as part of your recovery plan. You pay 20% of the approved cost per session. Medicare does not limit the number of sessions, but your therapist must show that you are making progress. If you stop improving, Medicare may stop covering sessions.

Hospital follow-up visits with your surgeon are covered under Part B. You pay 20% of the approved amount. If you need imaging or lab work during recovery, those are covered too, with you paying 20% after your deductible.

How supplemental insurance and Medicare Advantage plans affect your costs

A Medigap (supplemental) plan can pay some or all of the 20% you owe after Medicare pays its share. The exact coverage depends on which Medigap plan you have — some cover the full 20%, others cover part of it. If you have Medigap, show your card to your surgeon's office so they bill correctly.

A Medicare Advantage plan (Part C) covers hip replacement differently. These plans must cover everything Original Medicare covers, but they set their own deductibles, copays, and coinsurance amounts. Some Advantage plans charge a copay per visit instead of 20%. Call your plan before surgery to find out your exact costs and whether you need prior approval from the plan.

Questions to ask your surgeon and Medicare

Before scheduling, ask your surgeon's office: Does Medicare cover this procedure for my condition? Do you accept Medicare assignment? What is the estimated cost for my share? Will the surgery be inpatient or outpatient? What pre-surgery tests do you need, and what will those cost?

You can also call Medicare directly at 1-800-MEDICARE to confirm coverage for your specific situation. Have your Medicare card and your doctor's diagnosis ready. Medicare can tell you whether the procedure is covered and what your deductible status is.

If you have a Medigap or Medicare Advantage plan, call that plan's customer service number (on your card) and ask what you will owe for hip replacement surgery, including pre-surgery tests and post-surgery physical therapy.

What happens if Medicare denies coverage

If Medicare says the surgery is not medically necessary, you have the right to appeal. Your surgeon can help by submitting additional medical evidence — such as imaging results, notes about failed treatments, or a letter explaining why surgery is necessary for your specific case. Many denials are overturned on appeal.

If you disagree with Medicare's decision after appeal, you can request an independent review by a may have access to independent contractor. This process takes longer but is free. Your surgeon's office can guide you through the appeal steps.

If you choose to have surgery without Medicare approval, you are responsible for the full cost unless you signed a form agreeing to this before the procedure. Make sure you understand the financial risk before moving forward.

Frequently Asked Questions

Does Medicare cover both hips if I need surgery on each one?

Yes, Medicare covers hip replacement on each hip if both are medically necessary. However, surgeons typically perform one hip at a time, spacing them weeks or months apart to allow recovery. Your surgeon will discuss the timing with you. Each surgery has its own deductible and cost-sharing, so you will owe your share for each procedure.

What if my hip replacement fails and I need a second surgery?

Medicare covers revision hip replacement (surgery to repair or replace a failed implant) under the same rules as the original surgery. Your surgeon must document that the revision is medically necessary. You will pay your deductible and 20% coinsurance again, unless you have already met your deductible for that year.

Does Medicare cover the cost of the artificial hip joint itself?

Yes, the cost of the implant is included in the approved amount Medicare pays for the surgery. You do not pay separately for the joint. However, if you choose a premium implant that costs more than the standard option, you may owe the difference.

Will I owe anything if I use an out-of-network surgeon?

If your surgeon does not accept Medicare assignment, they can bill you for the difference between their charge and Medicare's approved amount. This is called balance billing. Ask your surgeon's office whether they accept assignment before scheduling. If they do not, get a cost estimate in writing so you know what you might owe.

Can I have hip replacement if I have both Original Medicare and a Medicare Advantage plan?

You cannot have both at the same time. If you have a Medicare Advantage plan, that is your primary coverage for hip replacement. Call your Advantage plan to find out what you will owe. If you want to switch to Original Medicare, you must disenroll from the Advantage plan first, which can only happen during the annual enrollment period or if you have a may have access to life event.