The average cost of knee replacement in the US is $35,000. That’s a lot of money!

So, if your doctor has recommended a knee replacement surgery, you must be wondering – is knee replacement covered by Medicare?

The good news is yes, Medicare covers knee replacement, but you must meet the eligibility criteria and follow the specified guidelines. 

Medicare guidelines for total knee replacement 2024 

You are eligible for coverage in 2024 if:

• All treatment options have failed to provide relief, and total knee replacement surgery is the only solution left. This makes the treatment medically necessary. 
• You have a written prescription from your doctor.
• You have documentation that details your health condition and the necessity for the procedure. 

Is there a Medicare knee replacement age limit?

There’s a common misconception that Medicare has set an age limit for knee replacement coverage. This is not true because all Medicare patients will receive the same coverage as long as they meet the eligibility criteria.

Does Medicare Advantage cover knee replacement?

Medicare Advantage (also called Part C) is a comprehensive plan that merges the benefits of Part A and B. It also includes additional perks like vision, dental, and prescription drug coverage. 

So, yes, Medicare Advantage covers knee replacement. However, please note this type of plans is offered by private insurance companies. They might require extra information to approve the coverage. 

If you’re a Part C enrollee, we highly recommend you contact the plan provider and confirm the eligibility criteria. 

Is robotic knee replacement covered by Medicare?

Robotic knee replacement is an advanced approach to performing the surgery. In this procedure, a robotic system assists the surgeon in carrying out the operation with a higher degree of precision.

The robotic system also allows the surgeon to make smaller incisions, which leads to less tissue damage and quicker recovery. Sometimes, the doctor may deem a robotic knee replacement surgery medically necessary for the patient. In this case, Medicare will cover the costs. 

What is the cost of total knee replacement if you are on Medicare?

There’s no fixed amount that patients pay for total knee replacement with Medicare. Your cost will depend on:

• Whether the surgery is performed in an outpatient or inpatient setting
• Types of tests
• Complexity of the case
• Medication and equipment used during surgery
• Number of days you will stay at the hospital after surgery

The cost is also affected by the hospital’s location. A hospital in Rhode Island will typically charge 30% more than a hospital in Kansas for the same procedure.

However, to give you an idea, here’s how Medicare covers the cost of total knee replacement surgery:

Medicare Part A 

Part A will pay 100% for the surgery, accommodation, meals, nursing service, and necessary treatment for up to 60 days. You will only have to pay the Part A deductible, which is currently $1,600 in 2023 and $1,632 in 2024.

However, once you exceed the 60 days, you will have to pay a fixed amount of $400 per day. 

Medicare Part B

Outpatient knee replacement surgery does not require a hospital night stay and is covered under Medicare Part B. So if you have paid the annual Part B deductible ($223 in 2023 and $240 in 2024), Medicare will pay 80% of the bill, and you will pay the remainder. 

Outpatient Setting	Medicare Paid	Patient Paid
Hospital	$12,487	$1,859
Ambulatory Surgical Center (ASC)	$8,496	$2,123

Medicare Advantage  

Since Part C plans are offered by insurance companies, each plan will have a different out-of-pocket cost. You must contact the plan provider to learn about deductibles, coinsurance, and copayments for knee replacement surgery.

What equipment does Medicare cover for knee replacement?

Medicare realizes that patients need certain devices to recover after a knee replacement surgery. And so, it provides coverage for durable medical equipment like:

• Commode Chair 
• Cane
• Crutches
• CPM 
• Walker
• Wheelchair or scooter

Please note that the equipment should be medically necessary, and you must have a written prescription from the doctor as evidence. 

Does Medicare cover inpatient rehab after knee replacement?

Yes, Medicare Part A covers inpatient rehabilitation after knee replacement. This includes rehabilitation services (like physical therapy), meals, a semi-private room, medication, and other hospital services. 

However, Part A will only pay 100% of these costs if you are shifted directly to a skilled nursing facility for rehab. Or you come back for rehab within 60 days of your discharge from the hospital. If you exceed this 60-day benefit period, you will have to pay coinsurance. 

Does Medicare cover in-home care after knee replacement?

Patients who are homebound or can’t leave their homes because of a medical condition will receive in-home care coverage after knee replacement. Medicare Part A will pay for all the necessary rehabilitation services and skilled nursing care.

You will only have to split the bill for durable medical equipment as it’s covered under Medicare Part B. So, you will pay 20% of the cost and Medicare will pay 80% – after you have paid the monthly premium.

Does Medicare pay for a walker after knee replacement surgery?

Yes, Medicare will pay for a walker after knee replacement surgery. It’s considered durable medical equipment. So, you will receive coverage under Part B. However, it should be medically necessary, and you should have a written prescription from the doctor.

Does Medicare cover physical therapy after knee Replacement?

Yes, Medicare will cover physical therapy after knee replacement. Medicare Part B that will cover 80% of the cost once you have paid your yearly deductible. If you have Medicare Advantage, physical therapy should also be covered.

Questions about Medicare?

Shoot us an email at medicare@hihella.com.