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Does Medicare Cover Hip Replacements


If you break a hip, a replacement may be necessary. When deemed medically necessary, Medicare will help cover the costs of hip replacement surgery. The price of hip replacement surgery may be different depending on the provider. Likewise, your costs can vary due to the variety of plans available. It’s important to talk to your doctor and medical team to ensure you know exactly how your coverage works before scheduling your surgery.

When performing hip replacement surgery, your surgeon will replace the hip with an artificial joint. Ceramic, hard plastic, and metal are elements in artificial joints. The most common reason for a hip replacement is due to arthritis damage according to the Mayo Clinic.

Does Medicare Pay for Hip Replacement Surgery?

Hip replacement surgery will fall under Part B. Part B covers 80% of your medical costs. You’ll be responsible for the remaining 20%, as well as other cost-sharing. If you have a Medigap plan the 20% coinsurance will be billed to them. Depending on what letter plan you have, you may even have all other cost-sharing covered. Meaning, you’ll pay zero for your hip replacement surgery.

Does Medicare Cover Hip Injections?

A patient with hip problems may hear that injections are a “middle of the road” treatment. Medications and physical therapy are the first steps; then, surgery is a last resort. The good news is, Medicare will cover some hip injections.

The two most common hip injections include:

  1. Platelet Rich Plasma (PRP) has been in the surgery world for 20+ years. But to the orthopedic world, it’s a newer method of treatment. The treatment uses the patient’s own immune system’s platelets found in the blood, then injected into the problem joint area. Healing happens through this stimulating of more collagen.
  2. Stem Cell Injections are “magic cells” that can multiply to help heal a wounded area. Injecting these anti-inflammatory and regenerative cells into a joint with arthritis may treat the area. This method doesn’t have FDA approval. Therefore, coverage isn’t available.

The less frequent injections include cortisone injections and Viscosupplementation injections. These may or may not be more beneficial for you; talk with your doctor to discuss your options.

Does Medicare Cover Cortisone Shots?

Medicare guidelines state that cortisone injections usually have coverage. Using this medication to treat inflammation, it goes directly into the problematic joint area. Make sure to check with your medical provider. Ask what the Medicare allowable amounts are for each service.

How Many Cortisone Shots will Medicare Cover?

Beneficiaries needing cortisone shots may have coverage for three cortisone shots annually. Repetitive injections may cause damage to the body over time. Therefore, many orthopedic surgeons suggest such a low number for each patient per year. Part B pays for the administration of any cortisone injections if a healthcare provider administers the drug.

Does Medicare Cover Gel Injections for Hip Pain?

Injections of hyaluronic acid, a gel-like substance, receive Medicare coverage for the treatment of knee osteoarthritis when medically necessary. Yet, hyaluronic acid/sodium hyaluronate injections don’t have FDA approval for use in hips or other joints.

There isn’t sufficient evidence for effective treatment of hip osteoarthritis nor temporomandibular joint osteoarthritis or disc displacement. Thus, it is not a practical, long-term solution for hip joint pain.

Do Medicare Supplements Cover Hip Replacements or Hip Injections?

While 20% of services may not seem like a lot left over to pay, many seniors are living on a fixed income. Procedures, services, and injections can cost upwards of hundreds, sometimes even thousands of dollars. Luckily, Medicare Supplement will cover the 20% coinsurance as well as additional cost-sharing in the form of deductibles and copays.

FAQs

How much does Medicare Plan G pay for hip replacement surgery?
Plan G will cover all of your cost-sharing minus the Part B deductible.
How long will Medicare allow me to have therapy and rehab after hip surgery?
There’s no limit on how many days Part B will cover outpatient rehab therapy as long as your doctor finds it medically necessary. For inpatient rehab, Part A will cover up to 60 days. After 60 days, you’ll have to pay coinsurance for each day.

How to Get Help Paying for Hip Replacement Surgery with Medicare

Depending on your individual healthcare needs – our team of licensed agents can get you the plan you need; at the best price. Our agents are available to help answer any questions or concerns you have. They’ll help compare rates and make sure you get the best policy that will help cover out of pocket costs from hip surgery and injections Give us a call at the number above, or fill out our rate comparison form.

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Lindsay Malzone

Lindsay Malzone is the Medicare expert for MedicareFAQ. She has been working in the Medicare industry since 2017. She is featured in many publications as well as writes regularly for other expert columns regarding Medicare. You can also find her over on our Medicare Channel on YouTube as well as contributing to our Medicare Community on Facebook.

5 thoughts on “Does Medicare Cover Hip Replacements

  1. I know that there is a limit of three cortisone injections per joint annually (and this is actually the max that is medically recommended also). Is there a time limit in between injections? I have had injections in my hand and shoulder where it took a couple of injections 4-6 weeks apart to get the inflammation under control. I have bursitis in my hip and had an injection a month ago that briefly helped and tried to schedule one for this week. The physician’s secretary said she thought insurance only covered the injection 3 months apart.

  2. will medicare cover hip replacement if the cortisone and physical therapy route does not precede the surgery.

    1. Hi Carol! As long your doctor says it’s Medically necessary and has documented your previous treatments, then yes Medicare will cover it.

    1. Hi Craig! There are many pain injections that are covered by Medicare including SIJ injections that are good for hip-related pain. Your doctor should be able to let you know what other injection options you have that Medicare will cover.

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