Knee pain can make life miserable. Walking, climbing stairs, even getting out of a chair can become a struggle. If your doctor says you need a knee replacement, your first question is probably: does Medicare cover knee replacement?
The good news: Yes, Medicare covers knee replacement surgery. It’s one of the most common surgeries for people on Medicare. But you’ll still have some out-of-pocket costs unless you have extra coverage.
This guide explains everything — what’s covered, what you’ll pay, and how to keep your costs as low as possible.
What Does Medicare Cover for Knee Replacement?
Medicare covers knee replacement surgery as a medically necessary procedure. Here’s what’s included:
Before surgery:
- Doctor consultations and evaluations
- X-rays and imaging (MRI, CT scan)
- Pre-surgical lab work and blood tests
- Pre-operative physical exam
The surgery itself:
- The surgical procedure
- Anesthesia
- The artificial knee implant (prosthetic)
- Hospital stay
- Medications given during your stay
After surgery:
- Physical therapy — both in the hospital and after discharge
- Home health care if you’re homebound after surgery (costs you $0)
- Skilled nursing facility care if needed
- Follow-up doctor visits
- Durable medical equipment (walker, cane, knee brace)
Medicare covers the full process from diagnosis through recovery. You don’t need to worry about whether individual pieces are covered — the whole journey is covered.
How Much Will You Pay for Knee Replacement on Medicare?
The total cost of knee replacement surgery ranges from $30,000 to $70,000 depending on the hospital and your location. Medicare pays most of it. Here’s what you owe.
If You Have Original Medicare Only
Part A (Hospital stay):
- You pay the $1,736 deductible for the hospital stay
- Days 1-60: $0 per day after the deductible
- Most knee replacement patients stay 1-3 days in the hospital, so you’ll likely only pay the deductible
Part B (Surgeon, anesthesia, outpatient services):
- You pay the $283 annual deductible (if you haven’t already met it)
- Then you pay 20% of the Medicare-approved amount for the surgeon’s fee, anesthesia, and other outpatient services
Estimated total out-of-pocket with Original Medicare only:
- Part A deductible: $1,736
- Part B deductible: $283 (if not already met)
- 20% of surgeon and other fees: $1,000 to $3,000
- Total: approximately $3,000 to $5,000
That 20% coinsurance is the expensive part. There’s no cap on Part B coinsurance under Original Medicare.
If You Have Original Medicare + Medigap Plan G
- Part A deductible: Covered by Medigap ($0 to you)
- Part B deductible: $283 (Plan G doesn’t cover this)
- 20% coinsurance: Covered by Medigap ($0 to you)
- Total: approximately $283
This is why Medigap saves you thousands. A knee replacement with Medigap Plan G costs you about $283. Without Medigap, it could cost $3,000 to $5,000.
If You Have Medicare Advantage
Your cost depends on your specific plan. Most Medicare Advantage plans charge:
- Hospital copay: $100 to $400 per day for the first few days
- Surgeon copay or coinsurance: varies by plan
- Out-of-pocket maximum: up to $8,850/year
The good news with Medicare Advantage is that your total costs are capped. Even if you hit complications, you won’t pay more than the plan’s out-of-pocket maximum.
Check your specific plan’s benefits before scheduling surgery. Call the number on your insurance card and ask: “What will knee replacement surgery cost me?”
Inpatient vs Outpatient Knee Replacement
This is important because where your surgery happens affects what you pay.
Inpatient (Hospital Stay)
Traditional knee replacement requires a hospital stay. You’re admitted, have the surgery, and stay 1-3 days to recover.
Medicare Part A covers the hospital stay. You pay the $1,736 Part A deductible.
Outpatient (Same-Day Surgery)
More and more knee replacements are now done as outpatient surgery. You go in, have the surgery, and go home the same day or the next morning.
When knee replacement is done outpatient, it falls under Medicare Part B instead of Part A. This means:
- No Part A deductible ($1,736 savings)
- But you pay 20% of all charges under Part B
- The 20% could add up depending on the facility
Which costs less? It depends on your situation. Outpatient avoids the Part A deductible but the 20% coinsurance can add up. Ask your surgeon and your insurance about the cost difference for your specific case.
If you have Medigap Plan G, both options cost you very little because Medigap covers the coinsurance either way.
How to Prepare for Knee Replacement on Medicare
Step 1: Get a Referral and Pre-Authorization
Your doctor needs to determine that knee replacement is medically necessary. This usually means:
- You’ve tried other treatments first (physical therapy, medication, injections)
- X-rays show significant joint damage
- Your knee pain significantly limits your daily activities
If you have a Medicare Advantage plan, you may need prior authorization before the surgery is approved. Call your plan to find out.
Step 2: Choose Your Surgeon and Hospital
Under Original Medicare, you can choose any surgeon and hospital that accepts Medicare. Compare surgeons based on:
- Experience with knee replacements
- Hospital quality ratings (check Medicare.gov Hospital Compare)
- Whether they accept Medicare assignment
Under Medicare Advantage, you’ll likely need to use an in-network surgeon and hospital. Going out of network could cost you much more.
Step 3: Understand Your Costs Before Surgery
Call Medicare (1-800-MEDICARE) or your Medicare Advantage plan and ask for a cost estimate. Know what you’ll owe before you get to the hospital. No surprises.
Step 4: Plan Your Recovery
Before surgery, set up your recovery plan:
- Ask your doctor about home health care after surgery — Medicare covers this at $0 if you’re homebound
- Arrange for someone to help you at home for the first 1-2 weeks
- Set up your home for safety — grab bars, shower chair, remove trip hazards
- Ask about physical therapy — you’ll need it for 6-12 weeks after surgery
Step 5: Get Pre-Surgical Clearance
Your doctor will order lab work, EKG, and a physical exam before surgery. Medicare Part B covers all of this. Make sure to schedule these well before your surgery date.
Recovery After Knee Replacement
Hospital Recovery (1-3 Days)
You’ll start physical therapy the day of or day after surgery. A therapist will help you stand, walk with a walker, and bend your new knee. Medicare covers all of this as part of your hospital stay.
Skilled Nursing Facility (If Needed)
If you can’t go home safely after the hospital, you may go to a skilled nursing facility for short-term rehab. Medicare Part A covers:
- Days 1-20: $0 per day
- Days 21-100: $217 per day (unless Medigap covers it)
Most knee replacement patients go directly home, not to a nursing facility. But it’s an option if you need it.
Home Recovery (6-12 Weeks)
This is where home health care shines. Medicare covers:
- A physical therapist visiting your home 2-3 times per week — $0 to you
- A nurse checking your surgical site and vitals — $0 to you
- A home health aide helping with bathing — $0 to you
Ask your surgeon to order home health care before your surgery. Have the agency ready to start visits the day you come home.
Outpatient Physical Therapy (After Home Health)
Once you’re no longer homebound, you’ll transition to outpatient physical therapy. Medicare Part B covers this at 80%. You pay 20% (or your Medigap plan covers it).
Most people need physical therapy 2-3 times per week for 6-12 weeks after knee replacement. Physical therapy is critical for a good outcome — don’t skip it.
Tips to Save Money on Knee Replacement
1. Get Medigap before you need surgery. A Medicare Supplement plan can save you $3,000 to $5,000 on knee replacement. But you need to buy it during your Medigap Open Enrollment Period for guaranteed acceptance.
2. Ask about outpatient surgery. Outpatient knee replacement avoids the $1,736 Part A deductible. Ask your surgeon if you’re a candidate.
3. Use home health care for recovery. It costs you $0 and you recover in your own home. It’s one of Medicare’s best benefits.
4. Compare hospital costs. Hospitals charge very different prices for the same surgery. Use Medicare.gov’s Hospital Compare to check quality and ask about costs.
5. Make sure your surgeon accepts Medicare assignment. This protects you from excess charges.
6. Do your physical therapy. People who complete their PT program recover faster, have better outcomes, and avoid costly complications.
Frequently Asked Questions
Does Medicare cover both knees at the same time? Yes. Medicare covers bilateral (both knees) knee replacement if your surgeon determines it’s medically necessary. However, most surgeons recommend doing one knee at a time for safer recovery.
Does Medicare cover robotic knee replacement? Yes. Medicare covers robotic-assisted knee replacement surgery the same as traditional surgery. The surgical approach doesn’t affect your coverage.
Does Medicare cover knee replacement revision surgery? Yes. If your artificial knee wears out or has problems and needs to be replaced again, Medicare covers revision surgery the same as the original surgery.
How long does a knee replacement last? Most artificial knees last 15 to 25 years. Some last even longer with proper care. If your knee eventually wears out, Medicare covers replacement surgery.
Does Medicare cover physical therapy after knee replacement? Yes. Medicare covers both home health physical therapy ($0 cost if homebound) and outpatient physical therapy (80% covered by Part B).
What if my Medicare Advantage plan denies knee replacement? You have the right to appeal. Ask your doctor to provide documentation showing the surgery is medically necessary. Many denials are overturned on appeal.
Does Medicaid help with knee replacement costs? If you qualify for both Medicare and Medicaid, Medicaid may pay your Medicare deductibles, copays, and coinsurance. This could reduce your out-of-pocket cost to $0.
What to Do Right Now
- If your doctor recommends knee replacement, ask about all treatment options first. Physical therapy, injections, and medication may help delay or avoid surgery.
- Check your Medicare coverage. Know whether you have Original Medicare, Medigap, or Medicare Advantage. This determines what you’ll pay.
- If you don’t have Medigap, consider buying it during Open Enrollment if you’re planning surgery. It could save you thousands.
- Ask your surgeon about home health care after surgery. Get it set up before your procedure so care starts immediately when you get home.
- Commit to physical therapy. Your outcome depends more on your PT effort than almost anything else. Do the exercises. Show up to every session.
Knee replacement can give you your life back. No more pain climbing stairs. No more struggling to walk. Medicare covers it — and with the right planning, your out-of-pocket costs can be very manageable.