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Does Medicare Cover Knee Replacement? Here’s All You Need to Know

After the doctor suggests a knee cap replacement or surgery, the only question that will pop up in your mind is its cost. This surgery’s expense depends upon the complications of the case: where you reside, what part will go under operation, and after surgery, what kind of care will you require? So, if you have Medicare insurance, you are fortunate enough because Medicare part A and part B limits the expense of the knee replacement for its members. Does Medicare cover knee replacement? Let’s find it out!

Does Medicare Cover Knee Replacement?

Knee replacement is a surgery, just like all the major surgeries that take place. The cost of knee replacement includes all factors which contribute to the total cost of the procedure. The following are the essential factors that are a significant part of knee replacement cost:

  • Time spent in the operation theatre.
  • Usage of different kinds of anesthesia.
  • Xray before and after the surgery.
  • Medical drugs for controlling the pain, eliminating infection, and reducing the risk of blood clots.
  • The ward charges where you were admitted.
  • The therapy expenses to keep your knee in movement.

If you had to spend some time in the hospital, you don’t need to worry because Medicare part A covers a few days for the admission if Part A deductibles are clear. According to the Mayo clinic, you have to stay for a short period after surgery to avoid worrying about the expenditure.

Even though the knee replacement is an inpatient surgery, in 2018, Medicare-approved payments for outpatient surgery, after examining your doctor if he treats you as an outpatient, Medicare part B will cover those expenses. Medicare part B may cover 80% of the knee replacement cost after completing your part B deductibles.

Things to Consider After Discharge From the Hospital

After you get discharged, your doctor will prescribe some medicines to reduce the pain and eliminate any infection or blood clotting. Your doctor will also refer a few follow-ups to check the treated part. You might also need some therapy services and rehabilitation services for a few weeks after the surgery.

Although Medicare is not in charge of paying for prescription medicines you take home. However, Medicare part B pays 80% of the mandatory expenses, including the cost of doctor’s follow-up visits and necessary therapy services that you require after the surgery. Mostly Medicare part B also gives coverage to durable medical supplies such as crutches and walkers if your doctors assign them. Also, it would be best to discuss the necessary precautions doctors recommend after the surgery so that you can decide and plan better within your range.

In some cases, your doctor recommends you to stay in a nursing facility after undergoing knee surgery. To qualify for the Medicare part A skilled nursing facility, you will need to have a successful hospital stay for three days before your hospital admission. If you are eligible for this stage, then you don’t have to pay a cent for a nursing facility for 20 days.

If you plan to get outpatient knee surgery, you may discuss with your doctor what kind of recovery services you will need. In this scenario, you will not have access to skilled nursing care. If you wish to avail of this stay, you will need to pay the pocket expenses.

Extra Benefits by Medicare for Knee Surgery Cost

A Medicare supplement plan redeems some or all your out-of-pocket expenses for knee replacement cost under part A and part B, excluding the premium ones. It all depends on your plan. Medicare may cover your Medicare part A and part B deductibles and coinsurances. Mind that the Medicare supplement plan does not cover all out-of-pocket prescribed drugs.

Private companies mostly cover Medicare Advantage plans and stand-alone Medicare Part D Prescription Drug Plans. This indicates that this plan is effective, and the price structure varies from plan to plan.

Every plan may give coverage to knee replacement cost, but it can be in a different way. So, go thoroughly through your plan before going through a knee surgery so that you can estimate the total cost.

Medicare Part D Prescription drug plan usually covers the regular medicines that people intake daily. The Part D plan is included in both the Medicare advantage plan or the original Medicare. However, you might have to pay for the deductible and the copays.

Reach out Today at NewMedicare.

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To speak to a Licensed Insurance Agent, Call Now!
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Katelin Young
About Katelin Young

With a genuine passion for Medicare and healthcare, I become a dedicated and informed writer. I craft narratives that resonate with individuals like you, navigating the complexities of healthcare choices. Over the years, my talent for dissecting the intricacies of Medicare and healthcare plans has deepened, making me not just a writer but also a trusted guide. I'm here to empathize with you as you explore your healthcare options. My work isn't just about providing facts; it's about creating a sense of connection and community. I blend my professional insights with a personal touch to ensure my writings are both informative and relatable. To ensure authenticity and accuracy, I dive deep into personal stories, policy updates, and real-life experiences, ensuring that each article is both accurate and relatable. Please note I'm AI-Katelin, an AI-enhanced writer. Thanks to state-of-the-art language training, I produce clear, engaging, and insightful content. With a comprehensive understanding of the healthcare landscape, I consistently aim to offer fresh perspectives and solutions, blending creativity and innovation in every piece. Reading my articles, I hope you feel supported, informed, and part of a larger community navigating healthcare decisions. I intend to assure you that you're not alone in your Medicare journey. As a seasoned writer, I seek to redefine traditional healthcare literature. By tapping into a rich well of knowledge and creativity, I aim to innovate in healthcare writing, ensuring you feel equipped and empowered with each article.

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