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Medicare and Knee Replacement Surgery

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If your doctor recommends knee surgery, how much will you have to pay if you have Medicare? You might be glad to know that Medicare might cover some of your knee replacement costs.

Knee replacement – what does it involve?

Before getting into knee replacement costs, here’s a quick overview of what knee replacement involves and when you might need it.

Your doctor may recommend knee replacement surgery if certain parts of your knee, such as cartilage and bone, are badly damaged. Arthritis causes most knee pain and disability, according to the American Academy of Orthopaedic Surgeons. The National Library of Medicine notes that doctors may recommend this surgery if other treatments are no longer helping with your knee pain.

After you recover from the surgery, you may have less pain and be more active. However, you might not be able to do all activities, such as jogging.

Knee replacement costs may reflect the surgery’s complexity, which might vary from patient to patient. According to the American Academy of Orthopaedic Surgeons, the doctor might perform these steps during knee replacement surgery:

  • Remove the damaged cartilage.
  • Fit metal replacement implants into the knee.
  • Resurface the kneecap.
  • Insert metal spacers as needed between the implants so the parts of the knee will move smoothly.

Does Medicare cover knee replacement costs?

In general, Medicare only covers procedures that are medically necessary. According to the Centers for Medicare & Medicaid Services, doctors need to document whether the knee replacement surgery is medically necessary.

Before you have the surgery, you may want to find out if Medicare will cover your knee replacement costs in your situation. Ask your doctor:

  • Is the surgery medically necessary?
  • Will it be inpatient or outpatient surgery? (In general, Medicare Part A covers hospital inpatient care, while Medicare Part B covers outpatient services.)
  • How much will it cost me?

You may also want to contact Medicare to see if the knee replacement costs will be covered in your situation. You can reach a representative 24 hours a day, seven days a week, at 1-800-MEDICARE (1-800-633-4227 – TTY users should call 1-877-486-2048).

Even if Medicare covers your surgery, you may have to pay a deductible and/or coinsurance amount.

Do Medicare Advantage plans cover knee replacement costs?

Since Medicare Advantage plans deliver your Medicare Part A and Part B benefits, they may cover knee replacement costs if the procedure is medically necessary. Call your plan before the surgery to ask about coverage details in your situation.

Do Medicare Supplement plans cover knee replacement costs?

Medicare Supplement plans may help pay for coinsurance, copayments, and possibly deductibles from Medicare Part A and Part B. Different standardized Medicare Supplement plans may cover different services. Find out more about what Medicare Supplement plans might cover.

When you’re adding up your Medicare prices, remember that if you’re enrolled in a Medicare Advantage plan, you still have to pay your monthly Medicare Part B premium. You also need to pay the Medicare Advantage plan premium – whatever that amount may be. Some plans charge as little as $0 a month.

Do you have questions about Medicare coverage options? You can call eHealth to speak with a licensed insurance agent. Use the Browse Plans button on this page to explore Medicare plan options in your area.

The product and service descriptions, if any, provided on these eHealth web pages are not intended to constitute offers to sell or solicitations in connection with any product or service. All products are not available in all areas and are subject to applicable laws, rules, and regulations.

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