Does Medicare Cover Hip Replacement?

If you're facing hip pain that limits your daily activities, you're not alone. More than 544,000 Americans undergo hip replacement surgery each year, with most patients being around 65 years old—right in the heart of Medicare eligibility. The good news? Medicare covers hip replacement surgery when it's medically necessary. But understanding what's covered, what you'll pay, and how to get the most from your benefits can feel overwhelming.

This guide breaks down everything you need to know about Medicare coverage for hip replacement in 2025 and 2026. We'll walk you through costs, coverage details, and how to prepare for surgery and recovery—all in plain language you can understand.

Yes, Medicare Covers Hip Replacement Surgery

Medicare covers hip replacement surgery when your doctor determines it's medically necessary. This means your hip pain and limited mobility haven't improved with other treatments, and surgery is the best option to restore your quality of life.

To qualify for coverage, you'll need:

Documentation of failed conservative treatments. Medicare wants to see that you've tried other options first. This might include physical therapy, medications, cortisone injections, or walking aids. Your medical records should show these treatments haven't provided enough relief.

Medical necessity certification from your doctor. Your physician must document that hip replacement is essential for your health and well-being. This isn't just about pain—it's about how hip problems affect your ability to walk, work, and live independently.

Imaging that shows joint damage. X-rays, MRIs, or CT scans need to show clear deterioration of your hip joint. This might be from arthritis, injury, or other conditions that have worn down the cartilage and bone.

According to Medicare.gov, coverage applies whether you have Original Medicare or a Medicare Advantage plan, though your costs may vary between plans.

What Parts of Medicare Cover Hip Replacement?

Medicare Part A Coverage

Medicare Part A covers your hospital stay for hip replacement surgery. This includes your room (usually semi-private), meals, nursing care, medications during your stay, and the operating room costs.

In 2025, you'll pay a $1,676 deductible for the first 60 days of your hospital stay. This deductible increases to $1,736 in 2026. Most hip replacement patients stay in the hospital for 1 to 3 days, so you typically won't face additional daily charges. However, if complications extend your stay beyond 60 days, you'll pay $419 per day (days 61-90) in 2025, or $434 per day in 2026.

Part A also covers your care if you need to transfer to an inpatient rehabilitation facility or skilled nursing facility after surgery. The good news? If you already paid your deductible for the hospital stay, you won't pay it again for rehabilitation in the same benefit period.

Medicare Part B Coverage

Medicare Part B handles the medical services side of your hip replacement. This includes your surgeon's fees, anesthesia, and any diagnostic tests before surgery. Part B also covers outpatient services you'll need during recovery, like physical therapy visits and durable medical equipment such as walkers or crutches.

For 2025, Part B charges a monthly premium of $185 and an annual deductible of $257. In 2026, the premium rises to $192.10 monthly with a $268 deductible. After meeting your deductible, you'll pay 20% coinsurance for covered services. Since hip replacement surgery can cost $30,000 to $40,000 total, your 20% share can add up quickly.

Medicare Advantage (Part C) Coverage

Medicare Advantage plans must cover everything Original Medicare does, but often add extra benefits. Many plans include perks that help with hip replacement recovery, such as:

• Transportation to medical appointments
• Meal delivery after you return home
• Gym memberships for post-recovery strengthening
• Lower out-of-pocket maximums that cap your yearly spending

The catch? You must use in-network providers, and you might need prior authorization before surgery. Check with your specific plan about coverage details and which surgeons and hospitals are in your network.

Medicare Part D Coverage

Medicare Part D covers the prescription medications you'll need after surgery. This typically includes pain medications for the first few weeks, blood thinners to prevent clots, and antibiotics to prevent infection. Each Part D plan has its own formulary (list of covered drugs) and costs, so review your plan to ensure your prescribed medications are covered.

Understanding Your Costs for Hip Replacement in 2025 and 2026

2025 Cost Breakdown

Here's what you can expect to pay with Original Medicare in 2025:

• Hospital stay (Part A): $1,676 deductible covers your entire stay if it's 60 days or less. Most patients stay 1-3 days, so this is usually your only Part A cost.
• Surgery and medical services (Part B): After your $257 deductible, you pay 20% of Medicare-approved amounts. For a typical hip replacement, this means about $2,000 to $2,100 out-of-pocket.
• Rehabilitation costs: If you need skilled nursing care, Medicare covers the first 20 days completely. Days 21-100 cost $204 per day. Outpatient physical therapy falls under Part B's 20% coinsurance.
• Total estimated out-of-pocket: Most patients pay between $3,500 and $5,000 total, depending on their rehabilitation needs.

2026 Cost Breakdown

Costs increase slightly for 2026:

• Hospital stay (Part A): $1,736 deductible
• ‍Surgery and medical services (Part B): $268 deductible, then 20% coinsurance‍
• Rehabilitation: Days 21-100 in skilled nursing will likely increase to around $210 per day (exact amount pending)

These estimates assume you have Original Medicare without supplemental coverage. A Medigap policy can significantly reduce these costs.

Inpatient vs. Outpatient Hip Replacement

Hip replacement surgery is shifting toward outpatient procedures. According to the American Academy of Orthopaedic Surgeons, over half of hip replacements may soon be same-day surgeries. This change affects your Medicare coverage and costs.

Inpatient surgery means you're formally admitted to the hospital. Medicare Part A covers your stay, and you'll pay the Part A deductible. You'll likely stay 1-3 nights for monitoring and initial recovery. This traditional approach is still common for patients with other health conditions or those over 85.

Outpatient surgery means you go home the same day. Medicare Part B covers the entire procedure, and you'll pay 20% coinsurance after your deductible. While you skip the hospital stay costs, your coinsurance might actually be similar to or slightly higher than the inpatient deductible.

Your surgeon will recommend the best option based on your overall health, support at home, and the specific type of hip replacement you need.

How Long Does Medicare Pay for Rehab after Hip Replacement?

Recovery from hip replacement involves different types of rehabilitation, and Medicare's coverage varies for each.

Inpatient Rehabilitation Facility (IRF) Coverage

If you need intensive therapy with round-the-clock medical care, you might go to an IRF. Medicare Part A covers up to 90 days per benefit period. You'll pay nothing for days 1-60 after meeting your Part A deductible. Days 61-90 require a $419 daily copayment in 2025. If you need more than 90 days, you can use your 60 lifetime reserve days at $838 per day in 2025.

Skilled Nursing Facility (SNF) Coverage

Most hip replacement patients who need facility-based rehabilitation go to a SNF. Here's the key requirement: you must have a qualifying 3-day hospital stay first (observation days don't count).

Medicare's SNF coverage breaks down like this:

• Days 1-20: Fully covered by Medicare
• Days 21-100: You pay $204 per day in 2025
• After day 100: You pay all costs

This 100-day limit resets with each benefit period, which begins when you enter the hospital and ends when you've gone 60 days without inpatient care.

Outpatient Physical Therapy Coverage

Many patients continue physical therapy after leaving a facility. Medicare Part B covers outpatient therapy as long as your doctor certifies it's medically necessary and you're making progress. There's no specific day limit, but your therapist must document improvement. You'll pay 20% coinsurance after meeting your Part B deductible.

Home Health Services Coverage

If you're homebound but still need therapy, Medicare covers home health services. A physical therapist can come to your home, and Medicare pays 100% of the cost (no deductible or coinsurance). You must be truly homebound—leaving home must be difficult and require considerable effort.

Pre-Surgery Requirements and Documentation

Before Medicare approves your hip replacement, you'll need to complete several steps. According to CMS guidelines, your medical record must clearly show why surgery is necessary.

Your doctor will document your history of hip problems, including how long you've had pain, what treatments you've tried, and how the condition affects your daily life. This might include difficulty walking, climbing stairs, getting dressed, or sleeping due to pain.

Most insurance plans require trying conservative treatments for at least 3-6 months. These might include:

• Anti-inflammatory medications
• Physical therapy
• Weight loss (if applicable)
• Cortisone injections (Medicare covers up to 3 per year)
• Walking aids like canes or walkers

Medicare also covers second opinions if you want another surgeon's perspective. This is especially valuable for complex cases or if you're unsure about surgery.

Some doctors now recommend "prehab"—physical therapy before surgery to strengthen muscles and improve outcomes. Medicare Part B covers prehab when your doctor prescribes it.

Post-Surgery Coverage Details

Your Medicare coverage continues throughout your recovery journey. Here's what's included after surgery:

Hospital discharge planning is covered under Part A. A discharge planner will coordinate your transition home or to a rehabilitation facility, arrange for medical equipment, and schedule follow-up appointments.

Follow-up visits with your surgeon are covered under Part B. Most patients have appointments at 2 weeks, 6 weeks, 3 months, and 6 months post-surgery. You'll pay 20% coinsurance for these visits.

Medical equipment you'll need at home is covered under Part B as durable medical equipment. This includes walkers (usually needed for 2-4 weeks), crutches, raised toilet seats, and shower chairs. Medicare pays 80% of the approved amount for rental or purchase.

Wound care is covered whether you're in a facility (Part A) or at home (Part B). If you need a visiting nurse for wound checks or staple removal, Medicare covers these services.

X-rays and imaging to check your new hip are covered under Part B. Your surgeon will likely order X-rays at several follow-up visits to ensure proper healing and positioning.

Medigap and Additional Coverage Options

Original Medicare leaves gaps in coverage—hence the name "Medigap" for supplemental insurance. These policies can dramatically reduce your hip replacement costs.

Plan F (only available if you were eligible for Medicare before 2020) covers all deductibles and coinsurance. You'd pay nothing out-of-pocket for a covered hip replacement.

Plan G is the most comprehensive option for new Medicare beneficiaries. It covers everything except the Part B deductible. For hip replacement, you'd only pay $257 in 2025.

Plan N offers lower premiums but requires small copayments for some services. You'd pay the Part B deductible plus up to $20 for office visits.

Remember, you can't have both Medigap and Medicare Advantage. If you have Medicare Advantage, check your plan's out-of-pocket maximum—this caps your yearly spending and might be lower than Original Medicare's costs for major surgery.

Common Medicare Coverage Denials and Appeals for Hip Replacement

Medicare rarely denies medically necessary hip replacements, but denials do happen. Common reasons include:

• Insufficient documentation of conservative treatment
• Missing imaging or test results
• Coding errors on claims
• Using out-of-network providers with Medicare Advantage

If Medicare denies coverage, you have strong appeal rights. According to the Medicare Rights Center, over half of appealed denials are eventually overturned. The key is acting quickly—you typically have 120 days to appeal.

Your appeal should include:

• A letter from your doctor explaining medical necessity
• Complete medical records showing your treatment history
• Imaging results demonstrating joint damage
• Documentation of how hip problems limit your daily activities

Preparing Financially for Hip Replacement

Planning ahead can prevent financial surprises. Start by calling your surgeon's office and the hospital to get cost estimates. Ask specifically about:

• The surgeon's fees
• Anesthesia charges
• Hospital or facility fees
• Estimated rehabilitation costs

Request these estimates in writing, and verify that all providers accept Medicare assignment. Providers who accept assignment agree to Medicare's approved amounts, which protects you from excess charges.

Consider setting aside money for expenses Medicare doesn't cover, such as:

• Transportation to appointments
• Over-the-counter pain medications
• Home modifications like grab bars
• Help with housework during recovery

If costs seem overwhelming, ask the hospital about financial assistance programs. Many hospitals offer payment plans or charity care for patients who qualify.

Choosing Medicare-Approved Providers

Using Medicare-approved providers is crucial for coverage and cost control. Providers who accept Medicare assignment agree to Medicare's approved rates and can't charge you more than the standard deductible and coinsurance.

To verify a provider accepts Medicare, use the Physician Compare tool on Medicare.gov or call their office directly. Ask these specific questions:

• Do you accept Medicare assignment?
• Is the surgical facility Medicare-approved?
• Will the anesthesiologist accept Medicare?
• Are the physical therapists in-network?

If you have Medicare Advantage, staying in-network is even more critical. Out-of-network care might not be covered at all, or you'll pay significantly more.

Alternative and Additional Treatments Covered

Medicare covers various treatments related to hip problems, not just replacement surgery:

Hip resurfacing is a less invasive alternative for younger, active patients. Medicare covers it when medically necessary, though not all patients are candidates.

Revision surgery is covered if your hip replacement fails or wears out. About 10% of hip replacements eventually need revision, typically after 15-20 years.

Injection therapies can postpone surgery:

• Cortisone injections: Medicare covers up to 3 per year
• Hyaluronic acid injections: Covered for knee arthritis, sometimes used off-label for hips
• Platelet-rich plasma: Generally not covered by Medicare

Pain management options covered by Medicare include physical therapy, prescription medications through Part D, and TENS units for electrical nerve stimulation.

What Medicare Doesn't Cover

Understanding what's not covered helps you budget accurately:

• Private hospital rooms aren't covered unless medically necessary. If you want a private room for comfort, you'll pay the difference yourself.
• Personal items like toiletries, telephone calls, or clothing aren't covered during your hospital stay. Pack what you need or arrange for someone to bring items.
• Transportation to and from medical appointments isn't covered by Original Medicare, though some Medicare Advantage plans include this benefit.
• Extended facility stays beyond medical necessity aren't covered. Once you can safely continue recovery at home, Medicare expects you to leave the facility.
• Experimental treatments or procedures not FDA-approved typically aren't covered. This includes some newer hip replacement materials or techniques still under study.

Recovery Timeline and Coverage Milestones

Understanding the typical recovery timeline helps you plan for coverage changes:

Days 1-3: Hospital Stay

Your hospital stay is covered under Part A after you meet your deductible. You'll start walking with assistance, usually within 24 hours of surgery—this early movement helps prevent blood clots and speeds healing. Physical therapists will teach you how to safely get in and out of bed, use the bathroom, and navigate stairs before discharge.

Weeks 1-3: Early Recovery

Whether at home or in a facility, you'll need significant help with daily activities during these first few weeks. Medicare covers skilled nursing care and intensive physical therapy during this crucial period, typically 3-5 sessions per week. You'll work on basic movements like bending your hip, building strength, and walking longer distances with a walker or crutches.

Week 6: Major Milestone

Most patients can walk without assistance and resume light activities like driving and returning to desk work. Outpatient therapy continues under Part B, usually reduced to 2-3 times per week as you gain independence. Your surgeon will likely schedule a follow-up appointment with X-rays around this time, which Medicare covers as part of your post-operative care.

Month 3: Significant Improvement

By three months, you're about 90% recovered and can handle most daily activities without restrictions. Many patients complete formal physical therapy, though Medicare continues coverage if your therapist documents ongoing need and progress. You might transition to a home exercise program or gym membership to continue building strength—some Medicare Advantage plans cover fitness programs.

Month 6: Full Recovery

Most patients return to normal activities, including low-impact sports and exercise. Medicare covers your final follow-up appointments and X-rays to confirm proper healing and positioning of your new hip. While formal therapy usually ends by now, Medicare will cover additional treatment if complications arise or if you need help reaching specific functional goals.

Special Circumstances and Considerations

Certain situations affect Medicare coverage:

Bilateral Hip Replacements

Bilateral hip replacements (both hips) can be done simultaneously in one surgery or staged weeks or months apart. Medicare covers both approaches, though simultaneous replacement means one hospital stay and deductible, while staged procedures require two separate deductibles. Recovery from simultaneous replacement is more challenging initially but eliminates the need for two separate recovery periods—your medical team will help determine which approach is safest for you.

Complications Coverage

Complications like infections, dislocations, or blood clots are covered when they occur, even months after surgery. Additional surgery, extended rehabilitation, or specialized treatments fall under the same Medicare rules as initial treatment, though you might enter a new benefit period if complications arise after you've been home 60 days. Medicare also covers revision surgery if your hip replacement loosens or fails years later, with no lifetime limit on hip replacement procedures.

Age Considerations

Patients over 85 might automatically qualify for inpatient surgery rather than outpatient, as Medicare recognizes older adults often need more monitoring and support. Medicare also understands that older patients typically require longer rehabilitation—your age alone won't limit your covered therapy days if you're making progress. Recovery might take longer for older adults, but Medicare continues coverage as long as your doctor documents medical necessity and improvement.

Weight Considerations

Severe obesity might require specialized equipment like reinforced operating tables, heavy-duty walkers, or bariatric hospital beds, which Medicare covers when documented as medically necessary. Some patients may need to use specialized rehabilitation facilities equipped for higher weight capacities—Medicare covers these facilities at the same rate as standard facilities. Your surgeon might recommend weight loss before surgery for safety reasons, and Medicare covers nutritional counseling and certain weight management programs when related to your hip replacement preparation.

How a Solace Advocate Can Help

Hip replacement surgery involves countless decisions, forms, and phone calls—all while you're dealing with pain. A Solace advocate takes on these burdens so you can focus on getting better.

Your advocate will handle prior authorization requirements, ensuring all documentation is complete before surgery. They'll work directly with your surgeon's office and insurance to prevent delays or denials. If Medicare does deny coverage, your advocate knows exactly how to file an effective appeal.

Finding the right rehabilitation facility can make or break your recovery. Your advocate researches facilities, checks Medicare ratings, verifies coverage, and even schedules tours. They'll ensure the facility you choose accepts Medicare and meets your specific needs.

Medical bills after hip replacement can be confusing. Your advocate reviews every bill for errors (studies show up to 80% contain mistakes), ensures Medicare is properly billed, and helps set up payment plans for remaining balances. They'll also identify financial assistance programs you might qualify for.

Perhaps most importantly, your advocate coordinates between all your providers—surgeon, primary care doctor, physical therapist, and rehabilitation facility. They ensure everyone has your current medical records, medications are properly managed, and nothing falls through the cracks during transitions.

Many Solace patients report saving thousands of dollars and avoiding weeks of stress by having an advocate handle their hip replacement journey. Medicare and many Medicare Advantage plans cover Solace advocacy services, making expert help accessible when you need it most.

Frequently Asked Questions about Medicare Coverage of Hip Replacement Surgery

Does Medicare cover hip replacement for arthritis?

‍Yes, Medicare covers hip replacement when arthritis causes significant pain and mobility problems that don't improve with other treatments. Osteoarthritis is the most common reason for hip replacement in Medicare patients. Your doctor must document how arthritis affects your daily activities and show that conservative treatments haven't helped.

What's the 3-day rule for skilled nursing facilities?

‍Medicare requires a 3-day inpatient hospital stay before covering skilled nursing facility care. These must be consecutive days as an admitted patient—observation days don't count. The admission must be for the same condition requiring skilled care. This rule ensures you truly need facility-based rehabilitation rather than outpatient therapy.

Can I choose my rehabilitation facility?

‍Yes, you have the right to choose any Medicare-certified rehabilitation facility with available space. Hospitals often recommend facilities they work with regularly, but you're not obligated to use them. Research facilities in advance, considering location, Medicare ratings, and specific programs for joint replacement recovery.

Does Medicare cover a second hip replacement?

‍Medicare covers revision surgery when medically necessary, whether due to infection, loosening, wear, or other complications. The coverage rules are identical to initial replacement. There's no lifetime limit on hip replacements, though multiple surgeries become more complex and might require specialized surgeons.

What if I need more than 100 days of rehabilitation?

‍After 100 days in a skilled nursing facility, Medicare coverage ends for that benefit period. You'll need to pay privately or through other insurance. However, if you're home for 60 days and then need facility care again (even for the same condition), a new benefit period begins with renewed coverage.

Conclusion

Medicare coverage for hip replacement is comprehensive but requires understanding the details. While Original Medicare covers the essential services—surgery, hospital stays, and rehabilitation—you'll still face significant out-of-pocket costs. In 2025, expect to pay at least $2,000 to $5,000 depending on your specific needs and recovery path.

Planning ahead makes all the difference. Choose Medicare-approved providers, understand your rehabilitation options, and consider supplemental coverage to reduce costs. Keep detailed records of your conservative treatments, as Medicare requires this documentation for approval.

Most importantly, don't face this journey alone. Whether through family support, medical professionals, or a patient advocate, having help makes the complex process manageable. Hip replacement can restore your mobility and quality of life—Medicare ensures it's financially possible.

This article is for informational purposes only and should not be substituted for professional advice. Information is subject to change. Consult your healthcare provider or a qualified professional for guidance on medical issues, financial concerns, or healthcare benefits.

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