Frequently Asked Questions
Does Medicare cover knee replacement surgery?
Yes — Medicare Part A covers knee replacement surgery when performed in a hospital inpatient setting. Medicare Part B covers the surgeon's fees and anesthesiology. You pay the Part A inpatient deductible ($1,676 in 2026) plus 20% of surgeon fees. With a Medigap Plan G, your out-of-pocket is limited to the Part B deductible.
Does Medicare cover hip replacement surgery?
Yes — Medicare covers hip replacement (total hip arthroplasty) the same way as knee replacement. Part A covers the hospital stay and Part B covers physician fees. Post-surgery rehabilitation at a skilled nursing facility is also covered by Part A for up to 100 days after a qualifying 3-day hospital stay.
How much does knee replacement cost with Medicare?
With Original Medicare, you pay the Part A deductible ($1,676 in 2026) for the hospital stay, plus 20% of surgeon and anesthesia fees. Total typical out-of-pocket: $2,000–$5,000 depending on complexity. With Medigap Plan G, you pay only the $257 Part B deductible — and nothing else for all covered services.
Does Medicare cover physical therapy after joint replacement?
Yes — Medicare Part B covers outpatient physical therapy after joint replacement. You pay 20% of approved costs after the Part B deductible. In-home physical therapy is covered under home health benefits if you are homebound. Medicare does not have a cap on medically necessary therapy visits.
Does Medicare cover outpatient knee replacement?
Yes — Medicare now covers many knee and hip replacements as outpatient procedures, which typically cost less than inpatient. For outpatient surgery, Part B (not Part A) covers the facility and surgeon fees, with 20% coinsurance after the deductible. Many patients now go home the same day or after one night.
Medicare covers knee and hip replacement surgery — one of the most common major surgeries for Americans over 65. Part A covers your hospital stay and Part B covers surgeon fees. But without supplemental coverage, your out-of-pocket costs can reach $3,000–$6,000. Here is exactly what to expect and how to minimize your costs.
What Medicare Covers for Joint Replacement
Medicare Part A — Hospital Stay
Part A covers your inpatient hospital admission including the operating room, anesthesia administered by hospital staff, nursing care, medications administered during your stay, meals, and semi-private room. You pay the Part A inpatient deductible of $1,676 in 2026 for days 1–60 of a benefit period.
Medicare Part B — Surgeon and Physician Fees
Part B covers your orthopedic surgeon's fee, anesthesiologist fee, and any consulting physicians during your admission. After your $257 annual Part B deductible, you pay 20% of approved amounts with no out-of-pocket maximum under Original Medicare.
Outpatient (Ambulatory Surgery Center) Option
Many joint replacements are now performed in outpatient settings — hospital outpatient departments or ambulatory surgery centers. For outpatient procedures, Part B covers the facility fee and physician fees (20% coinsurance applies). This is often less expensive than inpatient and recovery may be faster for appropriate candidates.
Medicare Coverage for Recovery and Rehabilitation
Skilled Nursing Facility (SNF) — Short-Term Rehab
If you need intensive rehabilitation after joint replacement and cannot manage at home, Medicare Part A covers short-term skilled nursing facility care — but only after a qualifying hospital stay of at least 3 consecutive inpatient days (not counting the day of discharge).
Coverage: Days 1–20 are fully covered ($0 copay). Days 21–100 require a daily copay of $209.50 in 2026. After 100 days, Medicare pays nothing — you pay full cost or use supplemental insurance.
Home Health Care After Surgery
If you are discharged home and cannot easily leave for outpatient therapy, you may qualify for Medicare-covered home health services including physical therapy, occupational therapy, and skilled nursing — at $0 copay. You must meet homebound criteria and your doctor must certify the need.
Outpatient Physical Therapy
Most joint replacement patients transition to outpatient physical therapy. Medicare Part B covers these visits at 80% of approved costs (you pay 20%). There is no longer a hard cap on medically necessary therapy visits — your doctor and therapist determine how many visits are needed.
Understanding Your Total Costs — With and Without Medigap
The difference between having Original Medicare alone versus Original Medicare plus a Medigap plan is dramatic for surgery:
| Cost Item | Original Medicare Only | With Medigap Plan G |
|---|---|---|
| Part A deductible (hospital) | $1,676 | $0 ✓ |
| Part B deductible | $257 | $257 |
| 20% surgeon fees (~$8,000 allowed) | $1,600 | $0 ✓ |
| SNF days 21–100 (if needed) | Up to $16,760 | $0 ✓ |
| Typical total out-of-pocket | $3,000–$6,000+ | $257 |
What to Do Before Your Surgery
- Confirm your surgeon and hospital both accept Medicare assignment
- Ask your surgeon whether your procedure will be inpatient or outpatient — this affects which Medicare part covers facility fees
- Understand your Part A deductible responsibility before admission
- If you have Medigap, call to confirm your surgery is a covered benefit
- Discuss post-surgery rehabilitation options with your surgeon before the procedure
- If you need SNF rehab, you must have a 3-day inpatient hospital stay — confirm this with your surgeon if SNF is likely
- Arrange home modifications before discharge: grab bars, shower chair, raised toilet seat