Does Medicare cover knee replacement surgery?

Does Medicare cover knee replacement surgery?

Yes. Medicare covers many medically necessary inpatient and outpatient surgical procedures, under Part A and Part B, and Medicare.gov names total knee replacement as one of the costly outpatient surgical procedures Part B covers as a comprehensive service. CMS says hip and knee replacements are the most common surgeries for Medicare beneficiaries.

CMS removed total knee arthroplasty (total knee replacement) from its inpatient-only list in calendar year 2018. To address that change, CMS's Comprehensive Care for Joint Replacement (CJR) payment model began including outpatient knee 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 knee 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. For example, if you go to a hospital for outpatient surgery and the hospital keeps you overnight for high blood pressure without an inpatient order, Part A pays nothing and Part B covers your doctor services and hospital outpatient services. Ask the hospital or your doctor about your status, because it affects what you pay. See how Medicare covers observation stays.

What do I pay for knee 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 knee 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. Costly surgical procedures called comprehensive services, like total knee replacements, are an exception: you pay 20% for the entire episode of care, including any drugs, laboratory tests and other services. In most cases, the copayment can't be more than the Part A hospital stay deductible ($1,736 in 2026) for each service.

To estimate your costs, 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 knee 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. You generally must enter the facility within 30 days of leaving the hospital and need daily skilled care. 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.
• 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.

What if I had an outpatient knee replacement and need nursing facility care?

Without a 3-day qualifying inpatient hospital stay, Original Medicare generally won't cover a skilled nursing facility stay. Medicare.gov says to ask whether you can get care in other settings, like home health care, or whether other programs, like Medicaid or veterans' benefits, can cover the care. You may not need the 3-day stay if your doctor participates in an Accountable Care Organization approved for a Skilled Nursing Facility 3-Day Rule Waiver, and Medicare Advantage Plans may also waive the 3-day minimum. Always ask your doctor or hospital staff whether Medicare will cover your stay. See how Medicare covers skilled nursing facility care.