Does Medicare cover hip replacement surgery?

Does Medicare cover hip replacement surgery?

Yes. Medicare covers many medically necessary inpatient and outpatient surgical procedures, under Part A and Part B. CMS says hip and knee replacements are the most common surgeries for Medicare beneficiaries, and CMS's CJR-X payment model for hospitals, which begins January 1, 2028, includes hip replacements performed in the inpatient or outpatient hospital setting, including hip replacement with a principal diagnosis of hip fracture.

CMS removed total hip arthroplasty (total hip replacement) from its inpatient-only list in calendar year 2020. To address that change, CMS's Comprehensive Care for Joint Replacement (CJR) payment model began including outpatient hip replacements, as well as inpatient ones, in its sixth performance year, which started October 1, 2021; that model ended December 31, 2024.

Will I be an inpatient or an outpatient for hip surgery?

Your doctor decides. You're an inpatient starting when you're formally admitted to the hospital with a doctor's order. An inpatient admission is generally appropriate when you're expected to need 2 or more midnights of medically necessary hospital care, but your doctor must order the admission and the hospital must formally admit you. You're an outpatient if you're getting outpatient surgery and the doctor hasn't written an order to admit you as an inpatient, even if you spend the night in the hospital.

If you come in through the emergency department, you're an outpatient until you're formally admitted as an inpatient based on your doctor's order. Once you're admitted, Part A covers your inpatient stay and, for most hospitals, all related outpatient services provided during the 3 days before your admission date, and Part B covers your doctor services. Ask the hospital or your doctor about your status each day you stay. See how Medicare covers observation stays.

What do I pay for hip replacement as an inpatient?

What you pay for each benefit period in 2026 depends on how long you're in the hospital:

• Days 1 to 60: $0 each day after you pay the Part A deductible ($1,736 in 2026). If you're in a Medicare Advantage Plan, you may be charged copayments during the first 60 days.
• Days 61 to 90: $434 each day.
• Days 91 to 150: $868 each day while you use your 60 lifetime reserve days.
• After day 150: you pay all costs.
• If you also have Part B, it generally covers 80% of the Medicare-approved amount for doctors' services you get while you're in the hospital.

What do I pay for hip replacement as an outpatient?

After you meet the Part B deductible ($283 in 2026), you pay 20% of the Medicare-approved amount for doctor or other health care provider services, and you generally pay a copayment for each service you get in a hospital outpatient setting. In most cases, the copayment can't be more than the Part A hospital stay deductible ($1,736 in 2026) for each service.

Because exact costs are hard to know in advance, Medicare.gov suggests asking the doctor, hospital or facility how much you'll pay for the surgery and any care afterward, checking with any other insurance you have, and looking at your secure Medicare account or your last Medicare Summary Notice to see if you've met your deductibles.

Does Medicare cover rehab after a hip replacement?

Medicare may cover rehab after surgery, depending on where you get it and whether you qualify:

• Outpatient physical therapy: Part B helps pay for medically necessary outpatient physical therapy, which helps restore or improve movement after an injury, illness or surgery, when your doctor or other provider certifies you need it. After the Part B deductible you pay 20% of the Medicare-approved amount, and there's no limit on how much Medicare pays for medically necessary outpatient therapy in a calendar year.
• Skilled nursing facility care: Part A covers it only after a qualifying inpatient hospital stay of at least 3 days in a row, not counting the day you leave the hospital. Time under observation or in the emergency room before you're admitted doesn't count. Days 1 to 20 cost $0 after the Part A deductible (which you don't pay again if you already paid it in the hospital in the same benefit period), and days 21 to 100 cost $217 each day.
• Inpatient rehabilitation: Part A covers medically necessary care in an inpatient rehabilitation facility if your provider certifies that you need intensive rehabilitation, continued medical supervision and coordinated care from your providers. You don't pay a deductible for inpatient rehabilitation if Medicare already charged you one for a prior hospital stay in the same benefit period, for example if you're transferred directly from an acute care hospital or admitted within 60 days of being discharged from a hospital.
• Home health care: Medicare-covered home health services include physical therapy (if you meet certain conditions) when you need part-time or intermittent skilled services and you're homebound, a doctor or other health care provider sees you in person, confirms you need home health care and orders your care, and a Medicare-certified home health agency provides it.

Does Medicare Advantage or Medigap change what I pay?

Medicare Advantage Plans must cover all medically necessary services that Original Medicare covers, and some offer extra benefits; rules and costs vary by plan. You may need approval (prior authorization) from your plan before it covers certain services or supplies, plans have a yearly limit on what you pay for covered Medicare services, and some plans may waive the 3-day hospital stay before skilled nursing facility care.

A Medigap (Medicare Supplement Insurance) policy helps pay your share of out-of-pocket costs in Original Medicare, like copayments, coinsurance and deductibles. See how Medicare Advantage differs from Original Medicare.