When hip pain turns grocery shopping into an endurance sport and getting out of a chair requires strategic planning, hip replacement surgery may offer meaningful relief. The obvious next question is whether Medicare will help pay for itor whether your new hip will arrive with a bill large enough to make the old one hurt again.
In most cases, Medicare covers hip replacement surgery when a doctor determines that the procedure is medically necessary. Coverage can include the operation, hospital or surgical-facility services, anesthesia, physician fees, rehabilitation, physical therapy, and certain equipment used during recovery. However, the part of Medicare that paysand the amount left for youdepends heavily on whether the procedure is classified as inpatient or outpatient care.
Does Medicare Cover Hip Replacement Surgery?
Yes. Original Medicare covers many medically necessary inpatient and outpatient surgeries, including total hip replacement, also called total hip arthroplasty. Medicare does not automatically approve surgery simply because an X-ray shows arthritis. Your medical record must support the need for the procedure, and the providers and facilities involved must meet Medicare requirements.
A doctor may recommend hip replacement when severe joint damage causes persistent pain, stiffness, reduced mobility, or difficulty completing ordinary activities. Common reasons include osteoarthritis, rheumatoid arthritis, osteonecrosis, traumatic joint damage, and certain hip fractures.
Medicare generally expects evidence that less invasive options have been considered or attempted when appropriate. These may include:
- Prescription or over-the-counter pain medication
- Physical therapy and therapeutic exercise
- Weight-management strategies
- Mobility aids such as a cane or walker
- Activity modification
- Joint injections when medically suitable
Surgery may still be justified without a long parade of unsuccessful treatments when the hip is severely damaged, fractured, deformed, or causing rapidly declining function. Medicare coverage decisions are based on medical necessity, not on a requirement that patients suffer through every possible treatment like contestants on a particularly unpleasant game show.
Which Part of Medicare Pays for Hip Replacement?
Medicare Part A: Inpatient Hip Replacement
Medicare Part A generally covers the facility portion of your care when a physician formally admits you to a hospital as an inpatient. Covered services may include your hospital room, nursing care, operating-room services, medications administered during the stay, medical supplies, and other medically necessary hospital care.
For 2026, the Part A hospital deductible is $1,736 for each benefit period. After that deductible, beneficiaries generally pay no daily hospital coinsurance for days 1 through 60. Longer stays can trigger daily coinsurance, although an uncomplicated elective hip replacement usually involves a much shorter hospitalization.
Part B normally pays the separate professional charges from surgeons, anesthesiologists, radiologists, and other physicians, even while you are an inpatient.
Medicare Part B: Outpatient Hip Replacement
Total hip replacement can also be performed as an outpatient procedure in a hospital outpatient department or, for suitable patients, an ambulatory surgical center. Medicare Part B covers approved outpatient medical and surgical services, including facility and physician charges.
After the annual Part B deductible, which is $283 in 2026, Original Medicare usually pays 80% of the Medicare-approved amount for Part B services. The patient generally pays the remaining 20%, assuming the provider accepts Medicare assignment. Additional copayments or separate charges may apply for the facility, anesthesia, imaging, laboratory testing, therapy, and medical equipment.
Why Your Hospital Status Matters
Sleeping in a hospital bed overnight does not necessarily make you an inpatient. You may still be classified as an outpatient receiving observation services. Your status depends on whether a physician has written a formal inpatient admission order.
This distinction affects which deductible and coinsurance rules apply. It can also determine whether Medicare later covers care in a skilled nursing facility. Before surgery, ask one direct question: “Will I be admitted as an inpatient, or will I be treated as an outpatient?” It is not nosy. It is financially responsible nosiness.
How Much Does a Hip Replacement Cost With Medicare?
There is no single universal Medicare hip replacement price. Costs vary according to your hospital status, geographic area, surgical setting, implant, surgeon, anesthesia needs, complications, rehabilitation plan, and supplemental insurance.
Medicare’s official procedure price lookup provides national estimates for outpatient total hip arthroplasty and compares hospital outpatient departments with ambulatory surgical centers. However, the estimate may not include every separate service you eventually need. Medicare itself advises patients to ask the doctor and facility for an individualized estimate because the complete cost is often unknown until a care plan is established.
A Simplified Outpatient Example
Suppose your remaining Part B deductible is $283 and your Medicare-approved physician and outpatient service charges total $10,000. In an intentionally simplified calculation, you might pay the deductible plus approximately 20% of the remaining approved amount. That would be roughly $2,226.
Real billing is rarely that tidy. Facility fees, surgeon fees, anesthesia, imaging, postoperative visits, equipment, and therapy can be processed as separate claims. The hospital may also apply specific outpatient copayment rules. Use an estimate as a planning tool, not as a sacred prophecy carved into a titanium hip implant.
Original Medicare Has No Annual Out-of-Pocket Maximum
Original Medicare does not set a yearly limit on what you may spend out of pocket for Part A and Part B services. Supplemental coverage, Medicaid, employer or retiree insurance, or a Medigap policy may reduce your share. Medicare Advantage plans are required to have an annual maximum for covered Part A and Part B services, although the amount varies by plan.
Medicare Advantage Coverage for Hip Replacement
Medicare Advantage plans must cover medically necessary services covered by Original Medicare, but they use their own networks, copayments, deductibles, and authorization procedures. Your plan may require you to use an in-network orthopedic surgeon, hospital, rehabilitation provider, home health agency, and equipment supplier.
Many Medicare Advantage plans require prior authorization for certain services. Do not assume that approval of the surgeon automatically approves the hospital, implant, rehabilitation facility, and postoperative therapy. Contact the plan before surgery and request written confirmation of:
- Prior-authorization requirements
- In-network hospitals and surgeons
- Your inpatient or outpatient copayment
- Coverage for postoperative physical therapy
- Skilled nursing or inpatient rehabilitation benefits
- Coverage for walkers and other equipment
HMO plans generally require members to use network providers except in limited circumstances. PPO plans may allow out-of-network services but can charge substantially more. Medicare advises Advantage members to contact their plans because prior authorization is commonly required for certain services and supplies.
Does Medigap Pay for Hip Replacement Costs?
A Medicare Supplement Insurance policy, commonly called Medigap, can help cover certain deductibles, copayments, and coinsurance left by Original Medicare. The exact benefit depends on your standardized Medigap plan and enrollment date.
For example, some plans cover Part A hospital coinsurance, while others may help with the Part A deductible or Part B coinsurance. Medigap supplements Original Medicare; it cannot be used to pay Medicare Advantage copayments or deductibles.
What Related Hip Replacement Services Can Medicare Cover?
Preoperative Appointments and Testing
Medicare may cover medically necessary office visits, X-rays, laboratory tests, cardiac evaluations, imaging, and other assessments needed to determine whether surgery is appropriate and safe. Part B cost-sharing normally applies to outpatient services.
Anesthesia
Medicare covers medically necessary anesthesia based on the setting in which the surgery occurs. Part A may cover anesthesia services included in an inpatient hospital stay, while Part B covers applicable physician and outpatient anesthesia charges.
Physical Therapy
Medicare Part B covers medically necessary outpatient physical therapy. There is no fixed annual visit limit, although the therapy must remain reasonable, necessary, and properly documented. After the Part B deductible, the patient generally pays 20% of the Medicare-approved amount.
Home Health Care
Medicare may cover part-time or intermittent skilled nursing, physical therapy, occupational therapy, wound care, and limited home health aide services when you meet the eligibility requirements. You must generally be homebound, need qualifying skilled services, have a provider certify the need, and receive care from a Medicare-certified home health agency. Medicare does not normally pay for round-the-clock custodial care at home.
Walkers and Other Medical Equipment
Part B may cover medically necessary durable medical equipment such as a walker when it is prescribed for use in the home and supplied by a Medicare-approved supplier. After the Part B deductible, you generally pay 20% of the Medicare-approved amount. Both the prescriber and supplier must satisfy Medicare requirements.
Prescription Medication
Medications administered during a covered inpatient stay are normally included in the Part A hospital benefit. Part B covers only certain categories of outpatient drugs. Prescriptions you fill at a retail pharmacy after dischargesuch as pain medicine, antibiotics, or blood thinnersare generally handled through Medicare Part D or a Medicare Advantage plan that includes drug coverage. Formularies, copayments, and prior-authorization rules vary.
Does Medicare Cover Rehabilitation After Hip Replacement?
Medicare can cover rehabilitation in several settings, but the rules are different for each one.
Skilled Nursing Facility Care
Under Original Medicare, Part A generally requires a qualifying inpatient hospital stay of at least three consecutive days before it will cover skilled nursing facility care. The day of discharge does not count, and time spent in the emergency department or under observation does not count toward the three-day requirement.
You must also need daily skilled nursing or therapy, enter a Medicare-certified facility within the permitted time, and meet the other eligibility rules. In 2026, eligible patients generally pay $0 per day for days 1 through 20 after the applicable Part A deductible, $217 per day for days 21 through 100, and all costs after day 100. Medicare Advantage plans may use different cost-sharing rules and may waive the three-day requirement.
Inpatient Rehabilitation Facilities
Part A can cover medically necessary care in an inpatient rehabilitation facility when a provider certifies that you require intensive therapy, ongoing physician supervision, and coordinated multidisciplinary care. Part B covers physicians’ services during the rehabilitation stay. Not every hip replacement patient needs this level of care; many recover safely at home.
What Medicare Usually Does Not Cover
Even when the operation is covered, Medicare does not pay for every recovery-related convenience. Common noncovered expenses may include:
- Long-term custodial nursing home care
- Full-time personal caregiving at home
- Meal preparation, housekeeping, and shopping assistance by themselves
- Private hospital or rehabilitation rooms unless medically necessary
- Home modifications such as ramps, wider doors, grab bars, or a walk-in shower
- Transportation that does not meet Medicare’s medical-necessity requirements
- Upgraded equipment or comfort items that are not medically necessary
Medicare may cover short-term skilled care, but it generally does not cover a permanent nursing home residence when the patient only needs help with bathing, dressing, eating, or other daily activities.
How to Confirm Coverage Before Surgery
- Ask whether the procedure is medically necessary. Confirm that your orthopedic surgeon has documented the diagnosis, symptoms, functional limitations, imaging findings, and previous treatments.
- Verify your hospital status. Find out whether the surgery is planned as inpatient, hospital outpatient, or ambulatory surgery.
- Confirm provider participation. Check the surgeon, anesthesiologist, hospital, laboratory, therapist, and equipment supplier.
- Request an itemized estimate. Ask for separate estimates for the facility, surgeon, anesthesia, implant, imaging, therapy, and equipment.
- Contact your Medicare Advantage plan. Confirm network status and prior authorization in writing.
- Review supplemental coverage. Check what Medigap, Medicaid, retiree insurance, or other coverage will pay.
- Plan rehabilitation early. Ask whether you are likely to go home, enter skilled nursing, or require inpatient rehabilitation.
- Check postoperative prescriptions. Make sure important drugs are covered by your Part D formulary.
Recovery, Risks, and Expected Results
Hip replacement is a major operation, but many modern patients begin walking shortly after surgery and may return home the same day when medically appropriate. Rehabilitation usually starts immediately with supervised walking, strengthening exercises, and instructions for safe movement. Johns Hopkins reports that many patients can walk and return home on the day of surgery, while incision healing commonly takes about six weeks.
Potential complications include infection, blood clots, dislocation, fracture, nerve injury, differences in leg length, loosening of the implant, and complications related to anesthesia. Blood-thinning medication and early movement may help reduce clot risk. Dislocation is uncommon but is more likely during the first few months while surrounding tissues heal.
Recovery speed differs dramatically. Some people resume many ordinary activities within six weeks, while strength and endurance can continue improving for several months. Age matters less than overall health, muscle strength, home support, and commitment to rehabilitation. The competitive sport of comparing yourself with the fastest patient in your physical therapy class is not Medicare-covered and is best avoided.
A Realistic Hip Replacement Experience: From Approval to Recovery
The following is a fictional composite based on common patient experiences. It is not a claim of personal medical experience and does not predict any individual result.
Imagine a 72-year-old Medicare beneficiary named Carol. For several years, she manages hip arthritis with medication, exercise, physical therapy, and the determined optimism of someone who insists the stairs are “not that bad” while gripping the handrail like it owes her money.
Eventually, the pain begins waking her at night. She stops walking around the neighborhood and starts planning errands according to the number of available chairs. Her primary care physician refers her to an orthopedic surgeon. X-rays show severe loss of joint space, and her records document that conservative treatments no longer provide adequate relief.
The surgeon recommends total hip replacement. Before choosing a date, Carol contacts the hospital and asks whether the procedure is expected to be outpatient. She also calls her Medicare Advantage plan. The first representative confirms that the hospital is in-network but cannot confirm the surgeon. Carol calls again, learns that the surgeon participates but one anesthesia group does not, and asks the hospital to assign an in-network anesthesia provider when possible. Ten minutes of mildly annoying phone music may save her a considerably more annoying bill.
Her plan requires prior authorization. The surgeon’s office submits her clinical notes, imaging results, and history of physical therapy and medication use. Approval arrives before the operation. Carol requests written confirmation and stores it with her estimate, medication list, insurance card, and recovery instructions.
Before surgery, Carol prepares her home. She moves loose rugs, clears walking paths, places frequently used items at waist height, and arranges for her daughter to stay for several days. Medicare does not pay for most household modifications or family caregiving, but these preparations reduce fall risks and make daily life easier.
On surgery day, Carol checks in early, answers the same medication questions several times, and briefly wonders whether the hospital is testing her memory rather than replacing her hip. The operation goes as planned. A physical therapist helps her stand and walk with a walker later that day. Because her pain is controlled, her vital signs are stable, and she can safely manage basic movements, she returns home rather than entering a rehabilitation facility.
Her early recovery is not entirely glamorous. Simple activities require planning. She keeps medications on a written schedule, performs ankle pumps and prescribed exercises, and takes short walks through the house. She uses ice as instructed and watches for increasing redness, drainage, fever, calf swelling, chest pain, or shortness of breath.
A Medicare-certified home health therapist visits because Carol meets the plan’s requirements and is temporarily homebound. The therapist checks her walking technique, reviews safe transfers, and adjusts her exercise program. Her walker was ordered by her physician and obtained through an approved supplier, so the plan covers it subject to the applicable cost-sharing rules.
During the second week, Carol becomes frustrated because progress is not a straight line. One day she walks confidently to the mailbox; the next day she feels tired after breakfast. Her therapist explains that variable fatigue is common and that recovery should be judged over weeks, not hour by hour.
By week six, Carol uses a cane only for longer outings and can manage most daily activities independently. She continues outpatient physical therapy, paying her plan’s required copayment. By the third month, she is walking farther than she could before surgery. She is not training for a marathon, but she can shop without scouting the furniture department for emergency seating.
Carol’s experience highlights an important truth: coverage is not only about whether Medicare pays for the implant and operating room. Successful planning also involves admission status, provider networks, prior authorization, medications, home support, equipment, rehabilitation, and an honest understanding of what Medicare does not cover.
Conclusion
Medicare usually covers hip replacement surgery when the procedure is medically necessary and properly documented. Part A generally handles inpatient hospital care, while Part B covers outpatient surgery and physician services. Rehabilitation, physical therapy, anesthesia, home health services, prescriptions, and mobility equipment may also be covered when their individual requirements are met.
Your final cost depends on much more than the surgery itself. Hospital status, provider participation, prior authorization, supplemental insurance, rehabilitation needs, and separate professional charges can all change the bill. Confirming these details before the operation can prevent unpleasant financial surprises and allow you to focus on the far more important job of recovering.
