MedicareFAQ
Coverage Q&A

Does Medicare Cover Hip Replacement Surgery?

How much does a hip replacement cost with Medicare? Medicare covers hip replacement surgery when your doctor determines it is medically necessary. Whether your procedure is performed as an inpatient or outpatient determines which part of Medicare pays and what you owe. Here is what you need to know about Medicare joint replacement coverage, recovery costs, and how to minimize your out-of-pocket expenses in 2026.

Updated July 6, 20268 min read
David Haass

Written By

David Haass

CTO & Co-Founder

Ashlee Zareczny

Reviewed By

Ashlee Zareczny

Reviewer

Watch the Video

Quick Answer

Part A (Inpatient): CoveredPart B (Outpatient): CoveredMedigap: Covered

Yes. Medicare covers hip replacement surgery (total, partial, and revision) when medically necessary. Medicare Part A covers inpatient hip replacement at a cost of $1,736 (the 2026 Part A deductible). Medicare Part B covers outpatient hip replacement at 20% coinsurance after your $283 annual deductible. More than half of all hip replacements are now performed as outpatient procedures. Medicare also covers physical therapy, skilled nursing facility stays, home health care, and durable medical equipment needed for recovery.

Coverage Comparison by Plan Type

Plan TypeCoverageNotes
Inpatient hip replacement (Part A)Covered$1,736 deductible per benefit period; $0 coinsurance for days 1-60 (2026)
Outpatient hip replacement (Part B)Covered20% coinsurance after $283 annual deductible; average patient cost $1,927-$2,154
Physical therapy and rehabilitationCoveredNo annual spending cap on medically necessary outpatient PT under Part B
Skilled nursing facility (post-surgery)CoveredDays 1-20: $0; Days 21-100: $218/day coinsurance (2026); requires qualifying hospital stay
Home health care (post-surgery)CoveredPT, OT, skilled nursing at home; $0 cost if you meet homebound criteria
Durable medical equipment (walker, crutches)Covered20% coinsurance under Part B after deductible

Understanding Your Coverage Options

Medicare Part A (Inpatient Hip Replacement)

Covered

If your surgeon determines that your hip replacement requires an inpatient hospital stay, Medicare Part A covers the surgery, hospital room, nursing care, meals, medications administered during your stay, and any necessary lab work or imaging.

In 2026, you pay the Part A deductible of $1,736 per benefit period. After that, you pay $0 coinsurance for days 1 through 60. If your stay extends beyond 60 days (rare for hip replacement), you pay $434 per day for days 61-90. Most inpatient hip replacements involve a 1-3 day hospital stay.

There is no limit on the number of hip replacements Medicare will cover over your lifetime, as long as each is medically necessary. Medicare also covers a second opinion from another surgeon under Part B if you want one before proceeding.

$ Cost: $1,736 Part A deductible per benefit period. $0 coinsurance for days 1-60.

Medicare Part B (Outpatient Hip Replacement)

Covered

More than half of all hip replacements in the United States are now performed as outpatient procedures, meaning you go home the same day or within 23 hours. CMS removed total hip arthroplasty from the Inpatient-Only list in 2020, making outpatient hip surgery under Medicare widely available.

Under Part B, you pay 20% of the Medicare-approved amount after meeting your $283 annual deductible. According to Medicare's Procedure Price Lookup tool, the average patient cost for outpatient total hip replacement (CPT 27130) is approximately $2,154 at an ambulatory surgical center and $1,927 at a hospital outpatient department.

Your surgeon's fees, anesthesia, implant costs, and facility fees are all included in the Medicare-approved amount. You do not need a qualifying hospital stay to access outpatient rehabilitation services afterward.

$ Cost: 20% coinsurance after $283 deductible. Average out-of-pocket: $1,927-$2,154.

Recovery and Rehabilitation Coverage

Covered

Medicare covers a comprehensive range of recovery services after hip replacement surgery. Outpatient physical therapy is covered under Part B with no annual spending cap, meaning Medicare will continue paying for medically necessary PT sessions as long as your doctor prescribes them. Most patients need 6-12 weeks of physical therapy after hip replacement.

If you need short-term skilled nursing facility (SNF) care after a qualifying 3-day inpatient hospital stay, Part A covers days 1-20 at $0 coinsurance and days 21-100 at $218 per day in 2026. Home health services are covered at $0 cost if you are homebound and need skilled care, including physical therapy, occupational therapy, and medical social services.

Medicare Part B also covers durable medical equipment like walkers, crutches, and canes at 80% of the Medicare-approved amount. Your doctor must certify that the equipment is medically necessary.

What It Covers

  • Outpatient physical therapy (no spending cap)
  • Skilled nursing facility days 1-100
  • Home health PT, OT, and skilled nursing
  • Walkers, crutches, canes, and other DME
  • Occupational therapy

$ Cost: PT = 20% coinsurance. SNF days 1-20 = $0. Home health = $0. DME = 20% coinsurance.

How Medigap Reduces Your Hip Replacement Costs

Covered

A Medicare Supplement (Medigap) plan can dramatically reduce your out-of-pocket costs for hip replacement surgery. With Medigap Plan G, your maximum cost for an inpatient hip replacement is $283 (the Part B deductible) because Plan G covers the Part A deductible, all Part A coinsurance, and all Part B coinsurance.

For an outpatient hip replacement, Plan G covers the 20% coinsurance, so you only pay the $283 Part B deductible instead of $1,927-$2,154. Plan G also covers SNF coinsurance for days 21-100, meaning your rehabilitation stay costs $0. There are no network restrictions with Medigap, so you can see any surgeon who accepts Medicare.

Compare this to Original Medicare alone, where an inpatient surgery costs $1,736 and outpatient costs $1,927-$2,154. Compare Medigap plans in your area to see what options are available. For a comparison of how Medigap protects you during major medical events, see our guide on how Medigap covers major surgery compared to Medicare Advantage.

$ Cost: Plan G = $283/year max out-of-pocket for hip replacement surgery.

Cost Comparison

Inpatient hip replacement: Original Medicare = $1,736 | Plan G = $283. Outpatient hip replacement: Original Medicare = $1,927-$2,154 | Plan G = $283.

Legislative and Policy Updates

CMS removed hip replacement from Inpatient-Only list (2020)

Passed

Total hip arthroplasty can now be performed in outpatient settings and ambulatory surgical centers, giving patients more options and often lower costs.

No annual cap on outpatient therapy spending

Passed

Medicare eliminated the therapy spending cap in 2018. There is no limit on how much Medicare will pay for medically necessary outpatient physical therapy in a calendar year.

SNF 3-day rule waiver for Medicare Advantage

Passed

Many Medicare Advantage plans have waived the 3-day qualifying hospital stay requirement for SNF admission, making it easier to access rehabilitation after outpatient surgery.

Frequently Asked Questions

How much does a hip replacement cost with Medicare in 2026?
Your cost depends on the setting. Inpatient: $1,736 (Part A deductible). Outpatient at a hospital: approximately $1,927. Outpatient at an ambulatory surgical center: approximately $2,154. With Medigap Plan G, your cost drops to $283 regardless of setting.
Does Medicare require prior authorization for hip replacement?
Original Medicare does not require prior authorization for hip replacement surgery. However, Medicare Advantage plans may require prior authorization before approving the procedure. Always check with your plan before scheduling surgery.
Can I have my hip replacement as an outpatient procedure?
Yes. Since 2020, Medicare covers total hip replacement in outpatient settings. More than half of all hip replacements are now performed as same-day or next-day discharge procedures. Your surgeon will determine if you are a candidate based on your overall health.
Does Medicare cover both hips if I need two replacements?
Yes. Medicare covers each hip replacement separately when medically necessary. Bilateral (both hips at once) procedures are covered, though most surgeons recommend staging them 3-6 months apart. Each surgery triggers its own benefit period and deductible under Part A.
How long does Medicare cover physical therapy after hip replacement?
There is no time limit or spending cap. Medicare Part B covers outpatient physical therapy for as long as your doctor certifies it is medically necessary. Most patients need 6-12 weeks of PT after hip replacement.
Does Medicare cover revision hip replacement surgery?
Yes. Medicare covers revision hip replacement (replacing a worn or failed prosthetic) under the same rules as the original surgery. Revision procedures are typically more complex and may require inpatient stays.
DH

David Haass

CTO & Co-Founder

David Haass is the Chief Technology Officer and Co-Founder of Elite Insurance Partners and MedicareFAQ.com. He is a member and regular contributor to Forbes Finance Council.

AZ

Ashlee Zareczny

Reviewer

Ashlee Zareczny is a licensed Medicare agent in all 50 states dedicated to educating those eligible for Medicare. She trains agents on CMS compliance guidelines.

Need Help Understanding Your Hip Replacement Costs?

Our licensed agents can help you compare Medigap plans that cover your hip replacement surgery costs. Get personalized guidance at no cost to you.