Free Guide to Hip Replacement Costs and Medicare

Understanding Hip Replacement Surgery and Its Costs

Hip replacement surgery, also called total hip arthroplasty, is a procedure where a surgeon removes a damaged hip joint and replaces it with an artificial joint made of metal, plastic, or ceramic materials. This surgery treats severe arthritis, hip fractures, and other conditions that cause pain and limit movement. According to the Centers for Disease Control and Prevention, more than 370,000 hip replacement surgeries occur annually in the United States.

The total cost of hip replacement surgery varies significantly depending on where you live, which hospital you use, and what complications may arise. National data shows that the average cost of hip replacement surgery ranges from $40,000 to $70,000 before insurance. Some hospitals charge as little as $30,000, while others charge over $100,000. These costs typically include the surgeon's fee, hospital facility charges, anesthesia, medical equipment, and post-operative care during your hospital stay.

Breaking down the typical bill helps you understand where your money goes. The hospital facility charge usually represents 40 to 50 percent of the total cost. The surgeon's fee typically accounts for 15 to 25 percent. Anesthesia services run 5 to 10 percent of the bill. Imaging tests, blood work, and the prosthetic joint itself make up the remainder. After you leave the hospital, additional costs may include physical therapy (often $2,000 to $5,000), prescription medications, and follow-up office visits.

It's important to understand that these figures are list prices, not what most people actually pay. Insurance coverage, including Medicare, typically reduces your out-of-pocket responsibility significantly. Uninsured patients sometimes negotiate lower rates directly with hospitals or may find that hospitals reduce charges based on financial hardship policies. Understanding the breakdown of costs helps you ask informed questions during your pre-surgery consultations.

Practical Takeaway: Before scheduling surgery, request an itemized cost estimate from your hospital. Ask whether prices include all pre-operative tests, the prosthetic device, surgeon fees, anesthesia, and post-operative care. Compare estimates from different facilities in your area, as costs can differ by $20,000 or more for the same procedure.

How Medicare Covers Hip Replacement Surgery

Medicare is a federal health insurance program for people age 65 and older, some younger people with disabilities, and people with end-stage renal disease. Medicare Part A covers inpatient hospital care, including hip replacement surgery performed in a hospital setting. This means Medicare pays for the hospital facility, surgeon's services, anesthesia, and related medical care during your hospital stay and recovery period.

When you have Medicare Part A and undergo hip replacement surgery, you are responsible for paying a deductible and coinsurance amounts. For 2024, the Part A deductible for each benefit period is $1,632. After you pay this deductible, Medicare covers 100 percent of your hospital costs for days 1 through 60 of your stay. For days 61 through 90, you pay a daily coinsurance amount of $408 per day. Most hip replacement surgeries require a hospital stay of 2 to 3 days, so most patients pay only the Part A deductible and no additional coinsurance.

However, Medicare Part A does not cover everything related to your hip replacement. Part A does not cover surgeon's fees or some related medical services. You need Medicare Part B to cover the surgeon's professional fee, which is typically 80 percent covered by Medicare after you pay your Part B deductible ($240 for 2024). You will be responsible for the remaining 20 percent of the surgeon's fee as coinsurance.

Outpatient rehabilitation and physical therapy after surgery may be covered by Medicare Part B if deemed medically necessary. Medicare Part B covers 80 percent of approved physical therapy costs after you meet your deductible. The remaining 20 percent is your responsibility unless you have supplemental insurance or are in a Medicare Advantage plan with different cost structures.

Many people with Original Medicare supplement their coverage with Medigap policies or enroll in Medicare Advantage plans. These plans can reduce or eliminate your out-of-pocket costs for hip replacement surgery. For example, some Medigap Plan G policies cover the Part A deductible and coinsurance amounts, while some Medicare Advantage plans have annual out-of-pocket maximums that limit your total costs.

Practical Takeaway: Review your current Medicare coverage before scheduling hip replacement surgery. Contact Medicare at 1-800-MEDICARE or visit Medicare.gov to understand your specific coverage details. Ask your surgeon's office to verify your coverage and obtain pre-authorization if required by your plan, as this protects you from unexpected bills.

Out-of-Pocket Costs Under Original Medicare

Patients with Original Medicare (Part A and Part B) typically pay out-of-pocket costs ranging from $1,500 to $3,500 for hip replacement surgery, depending on specific circumstances. This estimate includes your Part A hospital deductible, Part B surgeon deductible, and 20 percent coinsurance on the surgeon's professional fee. For a surgeon fee of $10,000, you would pay approximately $2,000 in coinsurance (20 percent) plus your deductibles.

The actual amount you pay depends on several factors. First, whether you have already met your deductibles earlier in the calendar year affects your surgery costs. If you've had other medical care earlier in the year and already paid your Part A and Part B deductibles, your out-of-pocket cost for hip replacement will be only the 20 percent coinsurance on the surgeon's fee. Second, the complexity of your surgery influences the surgeon's fee. A straightforward hip replacement costs less than revision surgery (replacing a previous implant) or surgery complicated by other medical conditions.

Post-operative costs add to your out-of-pocket responsibility. Physical therapy sessions typically cost $20 to $50 per session with Medicare Part B coverage. If you need 12 weeks of physical therapy at three sessions per week (36 sessions total), and you pay 20 percent coinsurance per session, you might pay $150 to $360 out-of-pocket for therapy alone. Prescription pain medications and antibiotics add another $50 to $200 to your costs, depending on whether you use generic medications and whether they are covered by your Medicare Part D plan.

Home health care services may be covered by Medicare Part A if you need skilled nursing or physical therapy at home instead of outpatient therapy. These services have no additional cost beyond your Part A deductible if you already paid it for your hospital stay. However, if home health agencies charge for services not covered by Medicare, you pay those costs directly.

Many Original Medicare patients find that their total out-of-pocket costs remain manageable, typically under $3,000, because Medicare covers the substantial hospital and facility costs. However, those without supplemental coverage should budget for these out-of-pocket amounts and plan accordingly with their healthcare providers.

Practical Takeaway: Create a detailed budget for your hip replacement that includes your deductibles, coinsurance percentages, physical therapy sessions, and medications. Contact your Medicare Part D prescription drug plan to confirm which pain medications and antibiotics are covered. Ask your surgeon's office for an estimate of how many physical therapy sessions they typically recommend, so you can calculate expected therapy costs.

Medicare Advantage Plans and Hip Replacement Coverage

Medicare Advantage plans, also called Medicare Part C, are health insurance plans offered by private companies approved by Medicare. These plans combine Medicare Part A and Part B benefits and usually include prescription drug coverage (Part D). More than 28 million Medicare beneficiaries are enrolled in Medicare Advantage plans, making them a common choice for hip replacement coverage.

Medicare Advantage plans must cover all services that Original Medicare covers, including hip replacement surgery. However, these plans differ from Original Medicare in how they structure costs. Instead of paying deductibles and coinsurance percentages, Medicare Advantage members typically pay copays for specific services. For example, your plan might require a $500 copay for a hospital admission and $50 copays for specialist visits, regardless of the actual costs. Many Medicare Advantage plans have annual out-of-pocket maximums, which means once you pay a certain amount (typically $5,000 to $7,000 in 2024), the plan covers all remaining medical costs for the year.

A major advantage of Medicare Advantage for hip replacement is the