What Medicare covers for hip replacement surgery

Medicare Part B covers hip replacement surgery itself — the surgeon's fee, the operating room, anesthesia, and the implant — after you meet your deductible. You pay 20% of what Medicare allows for the procedure once you've paid your Part B deductible (which is $240 in 2024, though this amount changes yearly). The surgeon and facility must accept Medicare assignment, meaning they agree to take Medicare's approved amount as full payment for their services.

The actual cost you see depends on where you have surgery. A hospital outpatient center, a surgical center, or an inpatient hospital stay each have different Medicare-approved amounts. If you stay overnight, you'll also owe a hospital inpatient copay instead of the outpatient 20% coinsurance. Hospital stays for hip replacement typically last one to three days, and your copay covers all days in that stay.

Key Takeaways

  • Medicare Part B pays 80% of the surgeon and facility costs after you pay your annual deductible, leaving you responsible for 20% coinsurance.
  • Your out-of-pocket cost varies widely based on whether surgery happens in a hospital, outpatient surgical center, or as an inpatient stay, ranging from roughly $3,000 to $15,000 or more depending on your location and the specific procedure.
  • Medigap supplemental insurance or a Medicare Advantage plan can reduce or eliminate your coinsurance and deductible costs.
  • Physical therapy after surgery is covered by Medicare Part B at 20% coinsurance, but only if ordered by your doctor and performed at a Medicare-approved facility.
  • You should ask your surgeon's office for the Medicare-approved amount before surgery so you can estimate your actual bill.

How much you actually owe out of pocket

Your out-of-pocket cost for hip replacement under Medicare ranges from roughly $3,000 to $15,000 or more, depending on your location, the facility type, and whether you have supplemental coverage. This estimate assumes you've already paid your Part B deductible. The Medicare-approved amount for hip replacement varies by geographic region — a procedure approved at $35,000 in one state may be approved at $28,000 in another.

If you have an outpatient procedure, you pay 20% of the Medicare-approved amount. If you're admitted to the hospital overnight, you pay a fixed copay per day (in 2024, this is $408 per day for days 1–3, though amounts change yearly). Many hip replacements involve a one- or two-night hospital stay, so your hospital copay might be $408 to $816 total, which is often less than the 20% coinsurance you'd pay for an outpatient procedure at the same facility.

These numbers do not include costs for pre-surgery testing, imaging, or post-surgery physical therapy — each is billed separately and has its own deductible and coinsurance rules under Medicare Part B.

What happens before and after surgery

Before hip replacement, you'll need X-rays, blood work, and possibly an EKG or other cardiac testing. Medicare Part B covers these at 80% after your deductible, so you pay 20% coinsurance for each test. If your surgeon orders them at the hospital where you'll have surgery, the hospital may bundle some costs into the surgical facility fee. Ask your surgeon's office which tests are included in the surgical bill and which will be billed separately.

After surgery, physical therapy is covered by Medicare Part B when your doctor orders it and you receive it at a Medicare-approved facility — typically an outpatient therapy clinic or a skilled nursing facility if you need inpatient rehabilitation. You pay 20% coinsurance for each therapy visit after your deductible. Most people need 8 to 12 weeks of therapy, which can add $1,500 to $3,000 in coinsurance depending on the number of visits and your location.

If you need inpatient rehabilitation after surgery — meaning you cannot safely go home and need 24-hour skilled nursing care — Medicare Part A covers this for up to 100 days per benefit period. You pay a copay of $204 per day for days 1–20 and 50% of costs for days 21–100 (in 2024). Many people stay 10 to 14 days in rehabilitation, which would cost roughly $2,000 to $2,800 in copays.

Supplemental insurance and Medicare Advantage plans

If you have a Medigap (supplemental) plan, it typically covers your Part B coinsurance and deductible, meaning you would owe little to nothing for hip replacement beyond your Medigap premium. The specific coverage depends on which Medigap plan you have — Plans C, D, G, and M cover the Part B deductible, while all Medigap plans cover the 20% coinsurance.

If you have a Medicare Advantage plan instead of Original Medicare, your costs work differently. Most Medicare Advantage plans have an out-of-pocket maximum — once you reach it in a calendar year, the plan pays 100% of covered services for the rest of that year. Your out-of-pocket maximum typically ranges from $5,000 to $10,000, though some plans have higher limits. You'll also have a copay or coinsurance for the surgery itself, usually $250 to $500 or 20% coinsurance, whichever your plan specifies.

Contact your Medigap or Medicare Advantage plan before scheduling surgery to confirm what you'll owe. Plans sometimes have different rates for in-network versus out-of-network providers, and some Medicare Advantage plans require prior authorization before surgery.

Getting a cost estimate from your surgeon

Before you schedule hip replacement, ask your surgeon's office for an estimate based on the Medicare-approved amount in your area. The office should be able to tell you the approved amount for the surgeon's fee, the facility fee, and any implant charges. Multiply the facility and surgeon fees by 0.20 (your 20% coinsurance) and add your remaining Part B deductible if you haven't met it yet.

Write down the names and Medicare provider numbers of your surgeon and the facility. You can verify the Medicare-approved amounts yourself by visiting the Medicare Physician Fee Schedule at cms.gov or calling Medicare at 1-800-MEDICARE to ask what the approved amount is for hip replacement in your zip code. This takes 10 to 15 minutes and gives you a real number to budget with.

Ask whether any pre-surgery tests or imaging are included in the surgical bill or billed separately. Ask whether the surgeon uses a standard implant or a custom implant, because custom implants sometimes have higher approved amounts. Ask what happens if you need revision surgery — whether your deductible resets or whether you're still in the same benefit period.

When to contact Medicare or your plan

Contact Medicare at 1-800-MEDICARE if you want to confirm the approved amount for hip replacement in your area, verify that your surgeon and facility accept Medicare assignment, or ask whether a specific implant is covered. Medicare can also tell you whether you've met your Part B deductible for the year.

If you have a Medicare Advantage plan, contact your plan directly before scheduling surgery to ask whether prior authorization is required, what your copay or coinsurance will be, and whether the surgeon and facility are in-network. If you have a Medigap plan, contact the plan to confirm that your coinsurance and deductible will be covered.

If your surgeon's office says a particular implant is not covered by Medicare, ask them to explain why. Some implants are covered under certain conditions — for example, if you have a specific type of arthritis or bone loss. If the implant truly is not covered, the surgeon should tell you the out-of-pocket cost for that implant before you agree to use it.

What to ask your doctor before hip replacement

Ask your surgeon whether the surgery will be done as an outpatient procedure or with an overnight hospital stay. This affects your cost significantly — hospital stays have a fixed copay, while outpatient procedures have 20% coinsurance. Ask whether the facility is a hospital, a surgical center, or an ambulatory surgery center, because Medicare-approved amounts differ.

Ask what implant will be used and whether it's a standard or custom implant. Ask how many physical therapy visits you'll likely need after surgery and whether they'll be outpatient or inpatient. Ask whether you'll need imaging or testing after surgery to confirm the implant is in place — some surgeons order follow-up X-rays, which are billed separately.

Ask what your surgeon's office will do if you cannot afford the out-of-pocket cost. Some offices have payment plans, financial counselors, or information about manufacturer information programs for implants. Ask whether the surgeon has performed the procedure many times and what their complication rate is, because complications mean additional costs and longer recovery.

Frequently Asked Questions

Does Medicare cover both hips if I need replacement on both sides?

Yes, Medicare covers hip replacement on both sides. If you have both done at the same time, you pay one deductible and one facility fee. If you have them done separately, you may pay two deductibles if the second surgery happens in a different calendar year. Ask your surgeon whether doing both at once is medically safe for you, because recovery is longer and more demanding.

What if my surgeon is out of network or doesn't accept Medicare assignment?

If your surgeon doesn't accept Medicare assignment, you may owe more than 20% coinsurance — up to 15% above the Medicare-approved amount. Original Medicare will still pay 80% of the approved amount, but you pay the difference. Ask your surgeon's office whether they accept assignment before scheduling. If they don't, ask for the total cost estimate in writing so you know what you'll owe.

Does Medicare cover the cost of a walker, crutches, or other equipment after hip replacement?

Yes, Medicare Part B covers durable medical equipment like walkers, crutches, and raised toilet seats when your doctor orders them. You pay 20% coinsurance after your deductible. You must rent or purchase the equipment from a Medicare-approved supplier. Ask your surgeon's office which suppliers they recommend and whether they can submit the order directly to the supplier.

What if I have a complication after surgery and need a second procedure?

If you need a second procedure in the same calendar year, you do not pay a new deductible — you've already met it. You pay 20% coinsurance on the new procedure's approved amount. If the complication happens in a new calendar year, you pay a new deductible plus 20% coinsurance. Ask your surgeon what the most common complications are and whether they're covered by Medicare if they occur.

Can I choose a specific implant brand, and does it cost more?

You can ask for a specific implant, but Medicare covers only implants that meet its standards. Most standard implants are covered at the same approved amount. Some newer or specialized implants may have higher approved amounts, and you'd pay 20% coinsurance on that higher amount. Ask your surgeon whether the implant you want has a higher cost and what the difference would be in your out-of-pocket bill.