Does Medicare Cover Hip Replacement Surgery?
How to use Medicare to pay for hip replacement surgery
For patients living with advanced hip arthritis, total hip replacement can provide significant pain relief and help restore mobility and independence. For patients who have Medicare, an important question is often how Medicare can be used to help pay for hip replacement surgery.
Dr. Alexander Tauchen is a board-certified, fellowship-trained orthopedic surgeon specializing in hip and knee replacement. He accepts Medicare as well as numerous Medicare Advantage plans and continues to welcome Medicare patients who need evaluation and treatment for hip arthritis.
Does Medicare cover hip replacement surgery?
Medicare can provide coverage for hip replacement surgery when the procedure is medically necessary and Medicare’s coverage requirements are met.
Hip replacement is generally considered when arthritis or another serious hip condition causes substantial pain and loss of function and nonsurgical treatment is no longer providing adequate relief.
Having Medicare does not necessarily mean that every expense associated with surgery will be paid in full. The amount a patient is responsible for can depend on the type of Medicare coverage, where the surgery is performed, deductibles and coinsurance, and whether the patient has supplemental insurance.
Which parts of Medicare help pay for hip replacement?
Different portions of Medicare may apply to different aspects of hip replacement care.
Medicare Part A primarily provides hospital coverage. If hip replacement requires an inpatient hospital admission, Part A may apply to eligible hospital expenses.
Medicare Part B provides medical coverage and generally applies to physician services and many outpatient medical services. This may include visits with the orthopedic surgeon, diagnostic testing and eligible physician services associated with surgery.
Many joint replacements are now performed as outpatient procedures. When hip replacement is performed on an outpatient basis, the way Medicare coverage applies can differ from an inpatient hospital stay.
Patients enrolled in a Medicare Advantage plan receive their Medicare benefits through a private insurance company approved by Medicare. Coverage requirements, provider networks and out-of-pocket expenses can vary by plan.
What about Medigap coverage?
Some patients with Original Medicare also have Medicare Supplement Insurance, commonly known as Medigap.
Medigap policies are designed to help cover certain out-of-pocket expenses that Original Medicare does not pay. Depending on the patient’s policy, supplemental coverage may reduce some of the deductibles, coinsurance or other eligible expenses associated with hip replacement.
Because Medicare coverage varies, patients should verify their individual benefits before surgery rather than assuming that all expenses will be covered.
What hip replacement services may be covered?
Hip replacement involves considerably more than the operation itself. A patient’s care may include an orthopedic evaluation, X-rays or other diagnostic studies, the surgical procedure, anesthesia, hospital or surgical facility services, the hip implant, medications and rehabilitation.
Coverage for these services depends on the patient’s Medicare benefits and the circumstances surrounding the procedure.
Dr. Tauchen’s office can help patients understand the anticipated components of their care, while Medicare or the patient’s Medicare Advantage or supplemental insurance provider can explain the specific benefits and financial responsibilities associated with their plan.
Does Medicare cover anterior hip replacement?
Dr. Tauchen specializes in anterior total hip replacement, a modern approach in which the surgeon accesses the hip joint from the front of the hip.
Medicare coverage is generally based on whether a hip replacement is medically necessary and whether applicable Medicare requirements are satisfied. Patients considering anterior hip replacement should discuss both their surgical options and insurance coverage with Dr. Tauchen and his team.
Does Medicare cover outpatient hip replacement?
Hip replacement does not always require a traditional inpatient hospital stay. Advances in surgical techniques, anesthesia, pain management and recovery protocols have made outpatient hip replacement appropriate for selected patients.
Dr. Tauchen offers outpatient hip replacement for appropriate candidates. Whether outpatient surgery is right for an individual patient depends on factors beyond insurance coverage, including overall health, medical history, home support and the surgeon’s assessment of what can be performed safely.
How much will I have to pay?
There is no single out-of-pocket price that applies to every Medicare patient having hip replacement surgery.
Costs can differ substantially depending on whether a patient has Original Medicare or Medicare Advantage, whether supplemental insurance is available, where the procedure is performed and which Medicare deductibles or coinsurance requirements apply.
Before scheduling surgery, patients should determine what their specific plan covers and what expenses they may be responsible for paying.
Do I have to be ready for surgery to see Dr. Tauchen?
No. Seeing a joint replacement specialist does not mean that you have committed to having surgery.
Dr. Tauchen evaluates each patient individually and recommends nonsurgical treatment when appropriate. For patients whose arthritis has progressed to the point that nonsurgical treatment is no longer providing sufficient relief, hip replacement may then be discussed.
Looking for a hip replacement surgeon who accepts Medicare?
Despite upcoming changes to Medicare physician reimbursement for joint replacement, Dr. Tauchen continues to accept Medicare and numerous Medicare Advantage plans.
If you have hip arthritis and are considering hip replacement, need a second opinion or are looking for an orthopedic surgeon who accepts Medicare, schedule a consultation with Dr. Alexander Tauchen.
Dr. Tauchen sees patients in Chicago’s western suburbs and specializes in modern hip replacement techniques, including anterior total hip replacement, outpatient hip replacement and revision hip replacement.