Hip Replacement Surgery: How Much Will My Medicare Cover?
Hip replacement surgery is one of the most common surgical procedures performed on Medicare recipients. Without coverage, the cost of hip replacement can be staggering and may top $40,000. Fortunately, Medicare does cover hip replacement surgery as long as it’s medically necessary and reasonable after other treatments fail to improve symptoms.
How Does Medicare Cover Hip Replacement?
If you have Original medicare, Part A coverage helps pay for the cost of an inpatient stay for your surgery including general nursing, a semi-private room, and drugs that are part of your treatment in the hospital. You will have a Part A deductible.
Part B coverage helps pay for treatment if surgery is performed in an outpatient facility. This coverage also pays for pre-operation doctor visits and tests such as X-rays, post-op physical therapy, and durable medical equipment such as a walker. You can expect to pay 20% of the Part B approved amount and your Part B deductible.
Part D pays for prescription drugs you may need as you recover from surgery.
If you have a Medicare Advantage plan, you have at least the same Part A and Part B benefits as you would with Original Medicare and you may have additional coverage such as an out-of-pocket maximum and prescription drug coverage, depending on your plan.
Anticipating Your Out-of-Pocket Cost for Hip Replacement
To understand how much you will pay for a hip replacement, you need to know what type of Medicare coverage you have and the details of your Medicare Advantage plan, if you have one.
Original Medicare will come with out-of-pocket costs for hip replacement surgery including your Part A deductible of $1,408 and copayments. Part A does have coinsurance but only if your hospital stay is longer than 60 days. Most hip replacement surgeries only require 1 to 3 days in the hospital which is covered by the $1,408 deductible.
Part B pays for medical treatments and appointments outside of your hospital stay. In 2020, most people pay a monthly premium of $144.60 for Part B coverage. There’s also a deductible of $198 per year. After you pay the deductible, Part B pays for 80% of the Medicare-approved amount of your treatment. You will be responsible for the remaining 20% of medical care you receive outside of the hospital.
Premium Medicare Options For Hip Replacements
To pay for prescription drugs following hip replacement, you have two options. You can enroll in Part D prescription drug coverage which is provided by a private insurance company and paid for in part by Medicare. In this case, the average premium is $34 per month.
You can also receive Part D coverage through a Part C or Medicare Advantage plan. A Medicare Advantage plan is more expensive but it can provide more comprehensive coverage with fewer out-of-pocket costs after surgery. Medicare Advantage plans usually have copayments instead of coinsurance which is a percentage of the total cost. A copayment will be a known amount such as $100 to see a specialist.
A final option that may be available to you is a Medigap or Medicare Supplement plan. A Medigap plan is offered by a private insurance company and it essentially picks up the bill where Original Medicare left off. Medigap plans only cover your out-of-pocket costs like deductibles and coinsurance but you can’t have both Medigap and Medicare Advantage coverage.
It’s important to compare Medigap and Medicare Advantage plans as both can reduce the cost of hip replacement surgery: one by boosting coverage and potentially replacing coinsurance with a predictable and possibly lower copayment and the other by taking care of all out-of-pocket costs after Original Medicare pays for your treatment.