Does Medicare cover knee replacement surgery?

Published by Medicare Made Clear®

Does Medicare cover knee replacement surgery?

If you need a knee replacement, you have plenty of company. In fact, more than 790,000 knee replacements are performed in the United States each year.1

Knee replacement surgery is common, but it’s still a major procedure. The weeks and months leading up to the operation may be a bit nerve-racking. The good news is that you can take some steps to help you feel prepared and to support a smooth surgery and recovery.

Step one is the most important – understand how Medicare will cover your knee replacement surgery.

How does Medicare cover knee replacements?

Getting a knee replaced requires surgery. And since Medicare only covers surgical procedures that are deemed medically necessary, your knee replacement surgery must be deemed medically necessary by your doctor for Medicare to cover it.

Which part of Medicare actually covers your surgery depends on what kind of surgery you get. If your knee surgery is in an inpatient procedure, Medicare Part A will provide coverage. If you get outpatient surgery, Medicare Part B would provide coverage. If you have a Medicare Advantage plan, your coverage may be different as well. Talk with your plan provider for specifics..2

Your costs will vary based on the type of procedure you need (inpatient or outpatient) and your Medicare coverage. If Medicare covers your surgery, you still likely will have costs including a deductible and coinsurance.

Other steps to prepare for knee surgery

Knee surgery can have a long recovery period, so here are some other helpful steps to prepare for your knee replacement.

1. Improve your health. Stop smoking if you currently do, eat healthy, and if you’re overweight, consider working with your doctor and a nutritionist to shed a few pounds before surgery.

2. Take the time to find the right surgeon. Who does your surgery and where can impact your procedure’s outcome, your recovery time and your total costs. Research and choose your surgeon carefully.

3. Make a recovery plan. Plan ahead for your recovery routine – exercise, physical therapy, home assistance, adaptions to getting around at home or outside – once you know what kind of procedure you are getting. And take it slow. It’s better to have a healthy, long recovery instead of accidently causing damage by trying to fast-forward things back to “pre-surgery normal.”

Usually with knee surgery you have time to consider your options and prepare yourself mentally, physically and financially for the procedure. Think of it this way: How much effort do you put in when you are buying a TV or computer or car? Shouldn’t you be doing at least as much for something as important as surgery? Talk with your Medicare plan provider and plan your knee surgery carefully.

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