Hip replacement surgery, or arthroplasty, can improve mobility when other treatments, such as medication, physical therapy, and walking aids have not been effective in reducing pain and increasing the functionality of the joint. Arthroplasty is performed over 100,000 times each year and has a 90% success rate. Many seniors who need hip replacement surgery are understandably concerned about the medical expenses they may incur before, during, and after the surgery. The surgery can cost between $30,000 and $40,000, but Medicare can help cover some of the costs.
Why You May Need Hip Replacement Surgery
There are several conditions that can wear down the hip joint including, but not limited to:
- Rheumatoid arthritis
- Avascular necrosis
- Bone tumors
Hip replacement surgery can restore the joint and its wide range of motion. Based on physician recommendations, your overall health, and your unique condition, the surgery may use cemented or uncemented prostheses to bond new parts of the joint to the healthy bone after diseased cartilage and bone tissue is removed. Recovery can take between 3 and 6 months but most patients report good results from the surgery.
How Medicare Can Help
According to the Centers for Medicare & Medicaid Services (CMS), Medicare will help cover the costs of hip replacement surgery when a patient’s symptoms have not responded to other treatments and a determination has been reached that major joint replacement is reasonable and medically necessary.
If you have Original Medicare, Part A (Hospital Insurance) will help cover your inpatient stay in a Medicare-approved hospital for your hip replacement surgery. Coverage includes general nursing, meals, semi-private rooms, and drugs that are part of your inpatient treatment. Most hip replacement surgeries will require you to spend one night in the hospital, but length of stay can vary. The Part A deductible will apply.
Your surgery may be performed in an outpatient surgical facility. In this case, Medicare Part B (Medical Insurance) will help cover the costs of your care. Part B benefits also include pre-op doctor visits and post-operative physical therapy and durable medical equipment (DME). DME may include a walker or cane ordered by your physician for use in your home after surgery while you regain your strength and balance. You will likely pay 20% of the Part B Medicare-approved amount for your services and supplies, and the Part B deductible applies.
Pain management is an important part of the recovery process. After surgery, your physician will create a pain management plan that may include prescription medications. Part D prescription drug coverage can help reduce your out-of-pocket medication costs.
If you are enrolled in a Medicare Advantage (MA) plan, you will have at least the same Part A and Part B benefits as Original Medicare, but many MA plans provide additional coverage, including prescription drug coverage and an annual out-of-pocket maximum. Check with your plan to find out your exact costs related to hip replacement surgery.