Does Medicare Cover Knee Replacement Surgery?
How to use Medicare to pay for knee replacement surgery
When knee arthritis progresses to the point that pain and loss of mobility interfere with everyday life, knee replacement may become an appropriate treatment option. For Medicare patients considering surgery, understanding how Medicare applies to knee replacement can make the process easier to navigate.
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 with knee arthritis.
Does Medicare cover knee replacement surgery?
Medicare can provide coverage for knee replacement when surgery is medically necessary and Medicare’s applicable coverage requirements are met.
Knee replacement is generally considered for patients with advanced arthritis or joint damage that causes significant pain and functional limitations, particularly when appropriate nonsurgical treatments are no longer providing adequate relief.
Medicare coverage does not necessarily mean that surgery will have no cost to the patient. Deductibles, coinsurance and other out-of-pocket expenses may apply.
Which parts of Medicare help pay for knee replacement?
The portion of Medicare that applies to knee replacement depends partly on the services provided and where care takes place.
Medicare Part A primarily covers hospital care. If a patient requires an inpatient hospital admission for knee replacement, eligible hospital services may fall under Part A.
Medicare Part B provides medical coverage and generally applies to physician services and many outpatient services. This can include orthopedic appointments, certain diagnostic services and eligible physician services associated with surgery.
Patients with Medicare Advantage receive their Medicare benefits through an approved private insurance plan. Individual Medicare Advantage plans can have different provider networks, authorization requirements and patient cost-sharing arrangements.
Can Medicare help pay for partial knee replacement?
Not every patient who needs knee replacement requires the entire joint to be replaced.
Partial knee replacement may be an option when arthritis is limited to an appropriate portion of the knee and the remaining areas of the joint are sufficiently healthy.
Dr. Tauchen performs robotic-assisted partial knee replacement for appropriately selected patients. Medicare coverage depends on medical necessity and applicable coverage requirements rather than simply whether a procedure is described as a partial or total knee replacement.
What about robotic-assisted knee replacement?
Dr. Tauchen specializes in robotic-assisted knee replacement with personalized knee alignment.
Robotic technology helps the surgeon plan and perform the procedure with detailed information about the patient’s anatomy. The goal is to create a knee replacement that accounts for the individual patient’s anatomy and alignment rather than treating every knee exactly the same way.
Patients considering robotic-assisted knee replacement should discuss their coverage with Dr. Tauchen’s office and their Medicare plan.
What knee replacement expenses may Medicare cover?
Knee replacement is an episode of care rather than a single medical expense. Depending on the circumstances, treatment can involve office visits, X-rays and other diagnostic studies, the surgeon’s services, anesthesia, the knee implant, hospital or outpatient surgical facility services, medications and rehabilitation.
Each component may be subject to different Medicare coverage and cost-sharing requirements.
Patients should verify their benefits before surgery so they understand which services are covered and what out-of-pocket expenses they should anticipate.
Does Medicare cover outpatient knee replacement?
Knee replacement has changed considerably over the past several years. Some patients who previously would have remained in the hospital can now undergo knee replacement on an outpatient basis.
Dr. Tauchen offers outpatient knee replacement for appropriate patients and uses modern rapid-recovery protocols.
Outpatient surgery is not appropriate for everyone. Age alone does not determine whether a patient can go home after surgery. Overall health, medical conditions, mobility, home support and other considerations are important when deciding where surgery should be performed and how long a patient should remain under medical supervision.
How much will knee replacement cost with Medicare?
There is no single answer because Medicare patients can have very different insurance arrangements.
A patient with Original Medicare and supplemental coverage may have different financial responsibilities than someone enrolled in a Medicare Advantage plan. Costs can also be affected by the surgical setting and the specific services required before, during and after surgery.
Patients should confirm their individual coverage and anticipated financial responsibility before proceeding with knee replacement.
Do I need to be ready for knee replacement before seeing Dr. Tauchen?
No. An appointment with a knee replacement specialist does not obligate a patient to undergo surgery.
Dr. Tauchen evaluates each patient individually. Nonsurgical treatment is recommended when appropriate, and knee replacement is considered when the severity of the arthritis, symptoms and limitations make surgery a reasonable option.
Patients can also see Dr. Tauchen for a second opinion if another surgeon has recommended knee replacement and they want to better understand their options.
Looking for a knee replacement surgeon who accepts Medicare?
Medicare physician reimbursement for joint replacement is changing, and some orthopedic practices may reconsider their participation in Medicare. Dr. Tauchen continues to accept Medicare and numerous Medicare Advantage plans.
If knee arthritis is interfering with your mobility and quality of life, or if you are considering total or partial knee replacement, schedule a consultation with Dr. Alexander Tauchen.
Dr. Tauchen cares for patients throughout Chicago’s western suburbs and specializes in robotic-assisted total knee replacement, robotic-assisted partial knee replacement, personalized knee alignment, outpatient knee replacement and revision knee replacement.