As we age, our joints naturally begin to break down due to wear, but this process can be exacerbated by excess weight and injury. In particular, the knee joint is one of the most susceptible to damage over time, and when severe wear or injury strikes the knee, mobility can become incredibly limited.
Thankfully, knee replacement surgery has come a long way in recent decades, allowing people to undergo minimally invasive procedures with faster healing times and more permanent replacement parts. This is good news for aging Americans as it means that fewer seniors have to suffer from mobility issues and can enjoy a great quality of life for longer periods of time. Likewise, the materials used in modern knee replacements are engineered more accurately and can be customized to fit each patient, allowing for fewer follow-up appointments and less resources spent by healthcare professionals
Medicare Coverage for Knee Replacement Surgery
One of the biggest concerns seniors and Medicare recipients under the age of 65 who qualify due to disabilities face is the costs associated with knee replacement surgery. In the majority of cases, knee replacement surgery and its associated treatments are covered under different parts of Medicare.
In order to be considered a good candidate for knee replacement surgery, you first need to receive screenings and treatment from your primary care physician who participates in Medicare and accepts assignment. Your primary doctor may also refer you to an orthopedic specialist. These doctors’ services are covered under Medicare Part B as they are performed on an outpatient basis. If surgery is the medically necessary option, then the surgery itself will be performed at a surgical center and should also be covered under Medicare Part B as an outpatient service. If you are admitted into a hospital for the surgery, Part A will help cover the costs of your stay.
Medicare Coverage During Recovery
If temporary recovery in a medical setting is required, a temporary stay in a skilled nursing facility will be covered by Medicare Part A. Recipients of Medicare benefits may also receive medications, clinical services and testing while staying in a skilled nursing facility, and each of these may fall under Medicare Part A or B depending on the service and the attending specialist.
After you return home after your surgery, you will likely need follow-up care and monitoring to determine if the surgery was a success or if further corrective action is required. These visits will once again be a part of Medicare Part B coverage. If any medications are prescribed to treat things like pain, to ward off infection or to strengthen tissue, these drugs will likely be covered under the prescription drug benefits outlined in Medicare Part D.
Understanding Your Plan’s Deductible
One thing that’s important to note when it comes to Medicare coverage and knee replacement surgery is that a patient will need to meet his or her plan’s deductible in order for services to be covered. The out-of-pocket cost to you will depend on your plan, but it may also depend on unique challenges or complications that come along with your specific needs. You may also need to discuss whether a full or partial knee replacement is the right solution as each procedure will come with differing costs and may require various different specialists in order to perform.
Keep in mind that knee replacement surgery, like all other major surgeries, can be expensive on your own, so make sure you understand your plan’s benefits prior to undergoing surgery. If surgery is not within your budget at the moment, you and your doctor may be able to find temporary alternative treatments through orthopedic support systems until the time is right to have the procedure.