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A hip replacement is where a damaged section of your hip joint is removed and replaced with an artificial join usually made of metal, ceramic, and very hard plastic. Arthritis damage is the most common reason to need a hip replacement, according to the Mayo Clinic.
If you’re suffering pain and compromised mobility because of a damaged or deteriorated hip, Medicare may cover some hip replacement costs.
Let’s take a look at how the various Medicare plans can help cover hip replacement costs.
Before you have a hip replacement, you will need various examinations, according to the Mayo Clinic. You may need a general physical examination to make sure you’re healthy enough to undergo surgery as well as an examination of your hip. You also may need blood tests, X-Rays, and an MRI. Medicare Part B generally covers most of these outpatient medical costs.
Medicare Part B may also cover outpatient physical therapy that you receive while you are recovering from a hip replacement. Medicare Part B also generally covers second opinions for surgery such as hip replacements.
You generally pay 20% of the Medicare approved amount for these services and the Medicare Part B deductible applies.
According to the National Institutes of Health (NIH) the hospital stay following a hip replacement can be as little as 24 hours. Medicare Part A may cover the time you have to spend in the hospital recovering as well as physical therapy you may receive in a skilled nursing facility.
Original Medicare (Part A and Part B) comes with out-of-pocket costs such as deductibles, and copayments for your hip replacement. Medicare Supplement (Medigap) plans available from private insurance companies may help with these costs.
There are ten standardized Medicare Supplement plans in most states (Massachusetts, Wisconsin, and Minnesota have their own standardized plans). Each standardized Medicare Supplement plan covers different amounts of these out-of-pocket costs. Medicare Supplement plans generally don’t cover prescription drugs.
Medicare Advantage plans are a way to get your Medicare Part A and Part B benefits from a private insurance company. Medicare Advantage plans must cover everything that Original Medicare (Part A and Part B) cover, except for hospice care, which is still covered by Part A. This means that Medicare Advantage also covers doctor visits, X-rays and MRIs, surgery costs, and physical therapy associated with your hip replacement.
A benefit of Medicare Advantage is that the costs are often copayments, rather than coinsurance. Coinsurance is a percentage, for example 20% of the overall cost. You don’t know what this amount will be in dollars until you receive a bill. A copayment is a known amount, for example $50, to see a specialist such as an orthopedic surgeon.
Your doctor may prescribe various drugs after your hip replacement surgery, such as blood thinning medication to prevent blood clots or pain killers. If you receive a general anesthetic or spinal block before the surgery, Medicare will generally cover this. However Medicare Part A and Part B usually don’t cover the medications you take at home.
That’s where Medicare Part D prescription drug coverage comes in. You can get Medicare Part D either through a stand-alone plan that goes alongside Original Medicare or through a Medicare Advantage Prescription Drug Plan.
Do you have any questions about your Medicare coverage of hip replacement? Feel free to enter your zip code on this page to start comparing Medicare plan options in your location.
eHealth's Medicare website is operated by eHealthInsurance Services, Inc., a licensed health insurance agency doing business as eHealth. The purpose of this site is the solicitation of insurance. Contact may be made by an insurance agent/producer or insurance company. eHealth and Medicare supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. We offer plans from a number of insurance companies.