How Much Does Hip Replacement Cost With Medicare?

Hip replacement surgery, a common orthopedic procedure, significantly improves quality of life by replacing a damaged hip joint with an artificial implant, restoring function and reducing discomfort. Understanding the financial aspects of this surgery, particularly with Medicare coverage, can be complex due to varying plans and potential out-of-pocket costs. This article clarifies how Medicare assists with hip replacement expenses and outlines the financial responsibilities individuals may encounter.

Medicare Parts and Hip Replacement Coverage

Medicare provides coverage for medically necessary hip replacement surgery through its various parts, each addressing different components of care. Original Medicare, comprising Part A and Part B, forms the foundation of this coverage. Medicare Part A primarily covers inpatient hospital stays, while Part B addresses medical services and outpatient care.

Medicare Part A

Medicare Part A, known as Hospital Insurance, helps cover costs associated with inpatient hospital stays, including the surgery itself and initial recovery in a hospital setting. For 2025, the Part A deductible for each benefit period is $1,676. After this deductible is met, Medicare Part A covers the full cost for the first 60 days of an inpatient hospital stay within a benefit period. If your hospital stay extends beyond 60 days within a benefit period, a daily coinsurance applies: $419 per day for days 61-90, and $838 per day for lifetime reserve days after day 90.

Medicare Part A also covers medically necessary skilled nursing facility (SNF) stays after a qualifying hospital stay of at least three consecutive days. For 2025, Part A covers the full cost of SNF care for the first 20 days within a benefit period. From day 21 to day 100, a daily coinsurance of $209.50 applies. After 100 days in an SNF within the same benefit period, the individual is responsible for all costs.

Medicare Part B

Medicare Part B, or Medical Insurance, covers services from doctors and other healthcare providers, outpatient care, and durable medical equipment. This includes surgeon’s fees, anesthesiologist services, pre-operative tests such as X-rays and MRI scans, and post-operative follow-up visits. If hip replacement surgery is performed in an outpatient surgical facility, Part B generally covers these associated costs.

For 2025, the standard monthly premium for Part B is $185.00, and the annual deductible is $257. Once the Part B deductible is met, Medicare typically pays 80% of the Medicare-approved amount for most services, leaving the individual responsible for the remaining 20% coinsurance. Part B also covers outpatient physical therapy and durable medical equipment like walkers or crutches, which are often necessary during recovery.

Medicare Part C (Medicare Advantage)

Medicare Part C, known as Medicare Advantage, offers an alternative way to receive Medicare benefits through private insurance companies. These plans are required by law to cover at least all the services that Original Medicare (Parts A and B) covers. However, Medicare Advantage plans often structure their costs differently, with varying premiums, deductibles, copayments, and coinsurance amounts.

Many Medicare Advantage plans also include prescription drug coverage (Part D) and may offer additional benefits not covered by Original Medicare, such as dental, vision, or hearing services. Enrollees in these plans typically have an annual out-of-pocket maximum for covered Part A and Part B services, which provides a financial safety net. For 2025, the maximum out-of-pocket limit for Medicare Advantage plans may not exceed $9,350 for in-network services.

Medicare Supplement Insurance (Medigap)

Medicare Supplement Insurance, or Medigap, is sold by private companies to help cover some of the out-of-pocket costs not paid by Original Medicare. These plans work in conjunction with Original Medicare, covering expenses such as Part A and Part B deductibles, copayments, and coinsurance. For instance, a Medigap plan could cover the 20% Part B coinsurance that Original Medicare does not pay, significantly reducing an individual’s financial responsibility. Medigap plans only work with Original Medicare and cannot be used with Medicare Advantage plans.

Potential Out-of-Pocket Expenses

Even with Medicare coverage, individuals will incur out-of-pocket expenses for a hip replacement. These costs include deductibles, copayments, and coinsurance, which are the patient’s share of the Medicare-approved amount for services.

Medicare Part D

Medicare Part D, which covers prescription drugs, also involves potential out-of-pocket costs. These can include a monthly premium, an annual deductible (up to $590 in 2025 for standard coverage), and copayments or coinsurance for medications. In 2025, there is an annual cap of $2,000 on out-of-pocket prescription drug costs for Part D and Medicare Advantage plans with drug coverage, after which covered prescriptions are free for the rest of the year.

Costs for services not fully covered by Medicare, such as certain long-term care beyond SNF benefits or specific assistive devices that do not meet Medicare’s strict durable medical equipment criteria, would be entirely the individual’s responsibility.

Balance Billing

While rare for hip replacements, balance billing can occur if a healthcare provider does not accept Medicare assignment. Balance billing is when a provider charges a patient for the difference between the provider’s charge and the Medicare-approved amount. If a non-participating provider (one who accepts Medicare but not assignment) treats a patient, they can charge up to 15% more than the Medicare-approved amount, known as the limiting charge. However, providers who have “opted out” of Medicare entirely can charge any amount, and the patient is responsible for the full bill, with no Medicare payment.

Medicare Advantage Out-of-Pocket

For those enrolled in Medicare Advantage plans, out-of-pocket costs are structured differently and depend on the specific plan’s terms. These plans have their own copayments and coinsurance for hospital stays, doctor visits, and other services. A significant feature of Medicare Advantage plans is the annual out-of-pocket maximum, which limits how much an individual will pay for covered Part A and B services in a year. Once this maximum is reached, the plan pays 100% of covered services for the remainder of the year.

Factors Influencing Your Cost

The total cost of a hip replacement, and consequently an individual’s out-of-pocket portion, can vary due to several influencing factors beyond Medicare’s standard cost-sharing. These variables reflect the dynamic nature of healthcare pricing.

Geographic Location

Geographic location significantly impacts the cost of hip replacement surgery. Healthcare costs, including facility fees and professional services, can differ substantially across states, cities, and even specific regions within a metropolitan area. This variation is often due to differences in local economic conditions, cost of living, and regional healthcare market dynamics. For instance, the average cost of hip replacement surgery without insurance can range from $30,000 to $50,000, with some reports showing ranges from $12,800 to $112,000, influenced by location.

Type of Facility

The type of facility where the surgery is performed also plays a role. Costs can vary between large teaching hospitals, smaller community hospitals, or outpatient surgical centers. Outpatient surgical centers may offer a lower overall cost for the procedure compared to inpatient hospital settings, with average total costs around $10,502 at an ambulatory surgical center versus $13,803 at a hospital outpatient department in 2024. The decision between inpatient and outpatient surgery depends on the patient’s medical condition and the surgeon’s assessment.

Surgeon and Anesthesiologist Fees

Surgeon and anesthesiologist fees, which fall under Medicare Part B, can vary based on their experience, reputation, and the complexity of the case. While Medicare sets approved amounts for these services, the actual charges from providers can differ, potentially affecting the 20% coinsurance paid by the patient. The surgeon’s fee alone can range from $1,500 to $5,000 or more, and anesthesia fees typically fall between $1,000 and $2,000.

Pre-operative and Post-operative Care Needs

Pre-operative and post-operative care needs can also influence the total cost. Extensive pre-operative diagnostic tests, additional consultations, or prolonged post-operative physical therapy can add to the overall expense. If a patient requires extended skilled nursing facility stays beyond Medicare’s covered days or more intensive rehabilitation, these additional services contribute to the financial outlay. The cost of rehabilitation can range from $1,000 to $3,000 depending on the number of physical therapy sessions required.

Unforeseen Complications

Unforeseen complications during or after surgery can substantially increase costs. Complications might lead to longer hospital stays, additional medical procedures, or more intensive and prolonged rehabilitation, all of which would result in higher bills.

Type of Implant

Finally, the type of implant used in the hip replacement can affect the overall cost. While Medicare generally covers medically necessary implants, the price of the artificial hip implant itself can range from $2,000 to $10,000 or more, depending on the material and manufacturer. Hospitals that perform a high volume of hip replacement surgeries often negotiate lower prices for implants, which can indirectly impact the overall cost passed on to the patient and Medicare.