Does Medicare Cover Hip Replacement Surgery? Key Facts

Hip replacement surgery is a major procedure that can restore mobility and relieve chronic pain, but the cost often raises concerns for older adults. If you or a loved one are approaching this surgery, understanding your coverage is essential. The short answer is yes, Medicare does cover hip replacement surgery when it is medically necessary. However, the specifics depend on your plan, the type of surgery, and where you receive care. This article breaks down how Original Medicare, Medicare Advantage, and Medigap handle hip replacement costs, what you can expect to pay out of pocket, and how to avoid surprise bills.

How Original Medicare Covers Hip Replacement Surgery

Original Medicare consists of Part A (hospital insurance) and Part B (medical insurance). For hip replacement surgery, both parts play a role. Part A covers inpatient hospital stays, including the surgery itself, while Part B covers outpatient services such as doctor visits, physical therapy, and durable medical equipment like walkers or crutches.

To qualify for coverage, your doctor must certify that the surgery is medically necessary. This typically means you have severe arthritis, a fracture, or other conditions that cause significant pain and limit daily activities. Medicare does not cover elective hip replacements for cosmetic reasons. Once approved, Medicare pays its share, and you are responsible for deductibles and coinsurance.

Part A Coverage Details

Part A covers your hospital stay for hip replacement surgery. In 2026, the Part A deductible is $1,632 per benefit period. This deductible covers your first 60 days in the hospital with no additional coinsurance. If your stay extends beyond 60 days, you pay daily coinsurance: $408 per day for days 61 through 90, and $816 per day for lifetime reserve days. Most hip replacement surgeries require a hospital stay of 1 to 3 days, so you will likely only pay the deductible.

Part B Coverage Details

Part B covers the doctor fees for your surgeon, anesthesiologist, and any other providers involved in your care. After you meet the Part B deductible of $233 in 2026, you typically pay 20% of the Medicare-approved amount for these services. This 20% coinsurance applies to outpatient physical therapy and any follow-up visits. For a hip replacement, the total Part B costs can range from $2,000 to $5,000 depending on your surgeon and location.

Medicare Advantage and Hip Replacement

Medicare Advantage (Part C) plans are offered by private insurers like Aetna and replace Original Medicare. These plans must cover everything Original Medicare covers, including hip replacement surgery. However, they often add extra benefits such as lower copays, dental coverage, or vision exams. The key difference is that Medicare Advantage plans use networks. You must choose a surgeon and hospital within the plan’s network to avoid higher costs. If you go out of network, your expenses could rise significantly or the plan may deny coverage entirely.

Before scheduling surgery, check your plan’s network and prior authorization requirements. Many Medicare Advantage plans require pre-approval for elective surgeries like hip replacement. Failure to obtain authorization could leave you with the full bill. In our guide on 2025 United Care for Medicare: Discover the Latest Updates and Benefits, we explain how plan changes can affect your out-of-pocket costs.

Medigap and Out-of-Pocket Costs

Medigap (Medicare Supplement Insurance) policies help cover the gaps in Original Medicare, such as Part A deductibles, Part B coinsurance, and excess charges. If you have a Medigap plan, your out-of-pocket costs for hip replacement surgery can be minimal. For example, Medigap Plan G covers your Part A deductible and Part B coinsurance after you pay the Part B deductible. Plan N covers most costs but requires small copays for doctor visits and emergency room visits.

Without Medigap, your total out-of-pocket costs for a hip replacement under Original Medicare could be $3,000 to $7,000 or more, depending on your hospital stay and follow-up care. With a comprehensive Medigap plan, you may pay only the Part B deductible and a few copays. This makes Medigap a valuable option for anyone anticipating major surgery.

What About Outpatient Hip Replacement?

Some patients are candidates for outpatient hip replacement surgery, where you go home the same day. Medicare covers outpatient surgeries under Part B, not Part A. This means you pay 20% of the Medicare-approved amount for the surgery and any facility fees, plus the Part B deductible. Outpatient surgery can lower your costs because you avoid the Part A deductible. However, you may face higher coinsurance for the facility fee. Discuss with your surgeon whether outpatient surgery is safe for you based on your health and home support.

Pre-Surgery Requirements and Prior Authorization

Medicare does not require prior authorization for hip replacement under Original Medicare, but your surgeon may need to submit documentation showing medical necessity. For Medicare Advantage plans, prior authorization is common. Start the process early to avoid delays. Your doctor’s office typically handles this, but you should confirm that authorization is obtained before the surgery date.

Post-Surgery Coverage: Physical Therapy and Equipment

After hip replacement, physical therapy is critical for recovery. Medicare Part B covers outpatient physical therapy, subject to the 20% coinsurance. There is no cap on therapy services, but your therapist must provide a plan of care that Medicare approves. You may also need durable medical equipment like a walker or raised toilet seat. Medicare Part B covers these items at 80% after the deductible. You must use a Medicare-enrolled supplier that accepts assignment.

If you need home health care after surgery, Medicare Part A or Part B may cover short-term skilled nursing or therapy at home, provided you are homebound and a doctor certifies the need. This coverage is limited to 60 days per episode with no copay for skilled care.

How to Minimize Your Costs

Here are practical steps to reduce your expenses for hip replacement surgery under Medicare:

• Confirm that your surgeon and hospital accept Medicare assignment. If they do not, you may face excess charges up to 15% above Medicare’s approved amount.
• If you have a Medicare Advantage plan, verify that your surgeon and facility are in-network and that prior authorization is secured.
• Consider a Medigap policy during your Medigap Open Enrollment Period (the 6 months starting when you turn 65 and enroll in Part B) to lock in lower premiums regardless of health conditions.
• Ask your doctor about outpatient surgery if you are a good candidate, as it may reduce your Part A deductible costs.
• Plan your surgery early in the year after you have met your Part B deductible, so the 20% coinsurance applies to fewer services.

By taking these steps, you can avoid surprise bills and keep your focus on recovery. For those with hearing loss, it is worth noting that Medicare also covers hearing evaluations if related to your overall health. Our article on Are Hearing Aids Covered by Medicare? Discover What Hearing Aids Medicare Will Pay offers insights into related benefits.

What If You Have Both Medicare and Medicaid?

Dual-eligible beneficiaries (those with both Medicare and Medicaid) typically have most or all costs covered. Medicaid often pays the Medicare Part B premium, deductibles, and coinsurance. For hip replacement surgery, you may owe nothing out of pocket. Check with your state’s Medicaid office to confirm coverage for any specific services.

Common Exclusions and Limitations

Medicare does not cover certain items related to hip replacement. These include:

• Private-duty nursing or personal care services (like help with bathing or dressing) unless you are receiving skilled home health care.
• Long-term care in a nursing home if you need custodial care rather than skilled care.
• Experimental procedures or devices not approved by the FDA.
• Transportation to and from appointments, except in limited emergency situations.

Understanding these exclusions helps you plan for additional expenses. If you need assistance managing your Medicare benefits, our resource on Blue Medicare Card: Easy Access to Your Medicare Coverage explains how to access your plan information quickly.

Frequently Asked Questions

Does Medicare cover hip replacement surgery for a fracture?

Yes. Hip fractures are considered medical emergencies and are covered under Medicare Part A if you are admitted to the hospital. The same cost-sharing rules apply as for elective surgery.

How much does a hip replacement cost with Medicare in 2026?

With Original Medicare, you can expect to pay the Part A deductible of $1,632 plus 20% of Part B costs. The total out-of-pocket typically ranges from $3,000 to $7,000 without supplemental insurance. With Medigap, costs drop to a few hundred dollars.

Does Medicare cover the entire hip replacement surgery?

Medicare covers the surgery and related hospital and doctor services when medically necessary. It does not cover the full 100% of costs. You are responsible for deductibles, coinsurance, and any excess charges from providers who do not accept assignment.

Can I choose any surgeon for my hip replacement with Medicare?

With Original Medicare, you can choose any doctor or hospital that accepts Medicare assignment. With Medicare Advantage, you must stay within the plan’s network unless it is an emergency.

Does Medicare cover hip replacement for arthritis?

Yes, if your arthritis causes significant pain and functional limitation, Medicare covers hip replacement as medically necessary. Your doctor must document that conservative treatments like physical therapy or medications have failed.

Planning Your Hip Replacement with Confidence

Knowing the answer to the question “does Medicare cover hip replacement surgery” is the first step toward a stress-free surgical experience. Medicare provides robust coverage for this procedure, but your final costs depend on your specific plan choices and providers. By verifying network participation, securing prior authorization if needed, and considering a Medigap policy, you can protect your finances. For those exploring other coverage options, our guide on Can Medicare Cover Braces? How to Navigate Your Benefits offers a similar breakdown of dental and orthodontic benefits. If you have questions about your individual situation, contact a licensed agent or call 833-203-6742 to discuss your options.