Your Guide to Medicare Hip Replacement Costs

What Medicare Actually Covers for Hip Replacement Surgery

Hip replacement surgery is one of the most common procedures Medicare covers, and understanding what that coverage includes is the first step in planning for this significant medical event. When you need a hip replacement, Medicare Part B steps in to cover the bulk of the surgical costs—but "covers" doesn't mean you pay nothing out of your pocket.

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Medicare Part B covers the surgeon's fee, the operating room, anesthesia, hospital stay for the procedure, and post-operative care during your hospital admission. For patients with Original Medicare (Part A and Part B), the surgery itself is typically handled under Part A if you're admitted to the hospital. The specifics depend on whether your surgery happens in an inpatient or outpatient setting.

Here's what matters: Medicare will pay 80% of what it determines is the "approved amount" for your hip replacement procedure after you've met your Part B deductible. That deductible was $240 in 2024, though it adjusts annually. The remaining 20% becomes your coinsurance responsibility. If your surgeon charges more than Medicare's approved amount, you may owe the difference—unless they're a "participating provider" who agrees to accept Medicare's payment as full compensation.

The approved amount for a hip replacement procedure varies by geographic location and facility type, but you can typically expect Medicare's approved charges to range from $15,000 to $30,000 for the procedure itself. That's before considering the cost of the hip implant itself, which Medicare does cover as part of the surgical procedure bundle.

The key takeaway: Don't assume Medicare covers everything. Request an itemized estimate from your hospital and surgeon's office before the procedure. Ask specifically what your surgeon charges versus what Medicare approves, and confirm whether your surgeon participates with Medicare. This conversation prevents surprises later.

Breaking Down Your Out-of-Pocket Costs

Your actual costs depend largely on which Medicare plan you have and when in the calendar year you have the surgery. Let's walk through the numbers for someone with Original Medicare and no supplemental coverage—this is the scenario where your costs are highest.

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First comes the Part B deductible. Once you pay $240 (the 2024 amount), Medicare starts paying its 80%. You then pay the remaining 20% of all approved charges related to your surgery and hospitalization. For a hip replacement procedure with an approved amount of $25,000, that 20% coinsurance would equal $5,000. Add your deductible, and you're looking at approximately $5,240 in coinsurance and deductible costs.

But there's more. If your surgery requires an overnight hospital stay, Part A comes into play. Part A has its own deductible—$1,632 in 2024 for each benefit period. However, if you've already used your Part A deductible earlier in the year for another hospital stay, you won't pay it again for your hip replacement during the same benefit period.

Here's where many people get confused: after Part A covers your hospital stay, you may face copays for any additional days. For days 1-60 of hospitalization, you pay nothing beyond the deductible. Days 61-90 require a daily copay ($408 per day in 2024). Most hip replacement surgeries result in 1-3 day hospital stays, so you typically won't hit these longer-stay costs.

The real variable is whether you have supplemental insurance (Medigap) or a Medicare Advantage plan. Medigap plans can cover your coinsurance, deductible, and copays, potentially reducing your costs to near-zero. Medicare Advantage plans have different cost structures—often lower premiums but higher out-of-pocket maximums and more restricted networks.

Practical takeaway: Before your procedure, call Medicare directly at 1-800-MEDICARE and ask for an estimate. Provide your specific diagnosis code for hip replacement. Then compare that estimate against your supplemental plan's terms. If you don't have supplemental coverage, investigate whether switching to Medigap makes financial sense—the premiums might pay for themselves through one surgery.

How Different Medicare Plans Change Your Bill

Your Medicare plan type fundamentally reshapes what you'll pay for hip replacement. Understanding these differences helps you make informed decisions about your coverage—especially if you're in an open enrollment period where you can make changes.

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Original Medicare (Part A and B) gives you the broadest choice of providers. Any doctor or hospital that accepts Medicare can treat you. As discussed above, you cover the deductible and 20% coinsurance. This is straightforward but potentially expensive for major procedures like hip replacement. Most hip replacement surgeries under Original Medicare result in total out-of-pocket costs between $2,000 and $8,000, depending on where in the year you have the procedure and whether the surgeon charges above Medicare's approved amount.

Medicare Advantage plans (Part C) bundle Part A and B coverage into a managed care plan with networks, lower premiums, and often no separate deductibles for surgery. Instead, these plans typically charge a copay for surgery—often $250 to $500 per procedure. However, Medicare Advantage plans have annual out-of-pocket maximums. In 2024, that maximum was capped at $7,550 for in-network care. Once you hit that maximum, the plan covers 100% of remaining costs. If your hip replacement and related care exceed that threshold, your costs stop there.

The catch with Medicare Advantage: your orthopedic surgeon and hospital must be in the plan's network. If you see an out-of-network provider, you'll pay much higher costs—sometimes significantly more than the in-network copay. Also, prior authorization is almost always required for hip replacement surgery under Medicare Advantage, meaning your surgeon must get approval from the plan before scheduling.

Medigap plans (supplemental insurance) work alongside Original Medicare, not replacing it. You still pay Medicare's deductible first, but Medigap covers varying portions of your coinsurance and copays depending on the specific plan letter (Plan F, Plan G, Plan N, etc.). Plan F, for example, covers your deductible and all coinsurance, meaning your hip replacement could cost you little to nothing out of pocket. Plan G covers coinsurance but not the Part B deductible. Plan N typically costs less in premiums but leaves some copays for doctor visits and emergency room visits—though these don't apply to hip replacement surgery itself.

Practical takeaway: Compare your current plan's costs against alternatives during open enrollment. If you have Original Medicare and no supplement, pricing out a Medigap Plan G or comparing a nearby Medicare Advantage plan could save thousands. Use Medicare's plan finder tool on Medicare.gov, or contact a licensed insurance broker who can model your specific scenario.

The Implant, the Surgeon's Experience, and Other Cost Variables

Hip replacement isn't a one-size-fits-all procedure, and several factors influence what Medicare pays and what you might owe. Understanding these variables helps you have more productive conversations with your healthcare team.

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The type of hip implant matters, though not always the way patients expect. There are different materials (metal-on-metal, ceramic-on-plastic, ceramic-on-ceramic) and different design approaches (traditional cemented, cementless, hybrid). Medicare covers all of these as medically necessary, and the cost of the implant itself is bundled into the overall surgical payment. You don't get an itemized bill for the implant. However, some newer implant technologies come with higher price tags, and if your surgeon selects a premium implant, your facility might pass along a facility fee supplement—this could be $1,000 to $5,000 beyond the standard Medicare approved amount. Understanding whether your surgeon uses standard or premium implants can help you anticipate costs.

Your surgeon's experience level doesn't change Medicare's payment for the procedure, but it can affect your outcome and recovery costs. Major academic medical centers and high-volume hip replacement surgeons typically have better outcome data and fewer complications, which means fewer readmissions, revision surgeries, or extended rehabilitations. While Medicare sets the surgical payment the same regardless of surgeon reputation, choosing a high-volume center can protect you from costs associated with surgical complications down the line.

The location where you have surgery—hospital versus ambulatory surgical center (ASC)—affects costs significantly. Medicare pays less for hip replacement at an ASC than at a hospital, primarily because you're not requiring an overnight stay. An ASC