Knee replacement is a common procedure for seniors, and Medicare covers it. Here's how coverage and costs work.
How does Medicare cover knee replacement?
Medicare covers total and partial knee replacement when your doctor determines it's medically necessary. How you're covered depends on where the surgery happens. If you're admitted as a hospital inpatient, Medicare Part A covers the hospital stay after you pay the Part A deductible. If the surgery is done on an outpatient basis, at a hospital outpatient department or ambulatory surgical center, Medicare Part B covers it and you pay 20% of the Medicare-approved amount after your Part B deductible. The surgeon's fee, anesthesia, and follow-up rehabilitation are also covered. Call 1-800-MEDIGAP at 1-800-633-4427 to understand your specific costs.
Rehab, recovery, and lowering your costs
Recovery is a major part of knee replacement, and Medicare covers it. Physical therapy is covered to help you regain strength and mobility, whether outpatient under Part B or, if you qualify, at home through the home health benefit. If you need short-term skilled nursing facility care after a qualifying inpatient stay, Part A may cover it. Under Original Medicare you're responsible for deductibles and coinsurance with no out-of-pocket maximum, so costs can add up. A Medigap plan can cover those gaps, making your total cost more predictable. For a free review of how to lower your knee replacement costs, call 1-800-MEDIGAP.