The short answer: Yes — Medicare covers hip replacement surgery when it is medically necessary. But how much you pay, which Medicare part covers the procedure, and how to reduce your out-of-pocket costs all depend on details most people don’t know until they’re already in the process.
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More than 544,000 Americans undergo hip replacement surgery each year, and the average age of a total hip replacement patient is 65.4 — right at Medicare eligibility. If you or a loved one is facing this surgery, understanding your Medicare benefits before scheduling can save you thousands of dollars and prevent unwanted surprises on your bill.
This guide covers everything you need to know about Medicare and hip replacement surgery, including 2025 and 2026 cost figures, eligibility requirements, inpatient vs. outpatient coverage differences, rehabilitation benefits, and how supplemental plans can reduce what you owe.
✅ Quick Answer: Medicare & Hip Replacement Surgery
- Covered: Yes, when medically necessary
- Inpatient surgery: Medicare Part A — you pay the $1,736 deductible (2026)
- Outpatient surgery: Medicare Part B — you pay 20% after the $268 deductible (2026)
- Rehab & physical therapy: Covered under Part A (inpatient) and Part B (outpatient)
- Durable medical equipment: Covered under Part B
- Not covered: Elective or cosmetic hip replacement
Does Medicare Cover Hip Replacement Surgery?
Medicare covers hip replacement surgery — also called total hip arthroplasty — when your physician determines the procedure is medically necessary. Coverage is available through Original Medicare (Parts A and B), Medicare Advantage (Part C), and can be supplemented by a Medigap policy.
To qualify for Medicare coverage, your doctor must document that:
- Imaging or clinical evidence shows advanced joint disease (such as osteoarthritis or rheumatoid arthritis)
- Non-surgical treatments — physical therapy, anti-inflammatory medications, corticosteroid injections — have been tried and failed to provide adequate relief
- You experience significant pain and reduced function in daily activities
- Structural joint abnormalities are present
- A prior replacement has failed (for revision surgery)
- You have cancer in the bones or soft tissue of the hip area
Medicare does not cover hip replacement performed for cosmetic reasons or without documented medical necessity. The distinction matters: before your procedure, confirm with your surgeon that the appropriate documentation is in your medical record.
Which Part of Medicare Covers Hip Replacement?
Original Medicare splits hip replacement coverage between Part A and Part B depending on whether your surgery is performed on an inpatient or outpatient basis. This is one of the most important planning decisions you and your surgeon will make before your procedure.
Medicare Part A: Inpatient Hip Replacement
If you are formally admitted to a hospital as an inpatient for your hip replacement surgery, Medicare Part A covers the facility costs. This includes:
- Semi-private hospital room and meals
- General nursing care
- Operating room fees
- Medications administered during your hospital stay
- Hospital supplies and equipment used during surgery
Most hip replacement patients stay in the hospital for one to three days, so you typically pay only the Part A benefit-period deductible with no additional daily coinsurance.
Medicare Part A Hip Replacement Costs (2025 & 2026)
| Cost Item | 2025 | 2026 |
|---|---|---|
| Part A deductible (per benefit period) | $1,676 | $1,736 |
| Days 1–60: daily coinsurance | $0 (after deductible) | $0 (after deductible) |
| Days 61–90: daily coinsurance | $419/day | $434/day |
| SNF days 21–100: daily coinsurance | $209.50/day | $217.50/day |
Medicare Part B: Outpatient Hip Replacement
Hip replacement surgery is increasingly performed on an outpatient or same-day basis. According to the American Academy of Orthopaedic Surgeons, over half of all joint replacements may soon be performed as outpatient procedures. When your hip replacement is outpatient, Medicare Part B covers:
- The surgeon’s fees
- Anesthesia services
- Ambulatory surgical center or hospital outpatient facility fees
- Pre-surgical diagnostic tests and lab work
- Post-operative follow-up visits
After meeting your Part B annual deductible, Medicare pays 80% of the approved cost. You pay the remaining 20%, which averages $2,000 to $2,100 for a typical outpatient hip replacement.
Medicare Part B Hip Replacement Costs (2025 & 2026)
| Cost Item | 2025 | 2026 |
|---|---|---|
| Part B monthly premium (standard) | $185.00 | $202.90 |
| Part B annual deductible | $257 | $268 |
| Medicare pays (after deductible) | 80% | 80% |
| You pay (coinsurance) | 20% (~$2,000–$2,100 avg.) | 20% (~$2,000–$2,100 avg.) |
Important: Always confirm that your surgeon, anesthesiologist, and facility all accept Medicare assignment — meaning they agree to Medicare’s approved rates. If a provider doesn’t accept assignment, they can charge up to 15% more than the Medicare-approved amount, which you’d owe out-of-pocket.
Inpatient vs. Outpatient Hip Replacement: Which Is Right for You?
Whether your surgery is classified as inpatient or outpatient has a significant impact on how Medicare pays — and how much you owe. Here’s a direct comparison:
| Factor | Inpatient (Part A) | Outpatient (Part B) |
|---|---|---|
| Hospital stay | 1–3 nights typical | Same-day discharge |
| Primary deductible (2026) | $1,736 per benefit period | $268 annual deductible |
| Your cost share | Deductible only (typical stay) | 20% coinsurance |
| SNF rehab eligibility | Yes (after 3-night qualifying stay) | No (must use outpatient therapy) |
| Best suited for | Older patients, complex conditions, patients 85+ | Healthier patients, lower surgical risk |
One often-overlooked rule: to qualify for Medicare-covered skilled nursing facility (SNF) care after surgery, you must have a qualifying inpatient hospital stay of at least three consecutive days. Days spent under “observation status” — where you are in the hospital but technically classified as outpatient — do not count toward this requirement. Ask your care team explicitly whether you are being formally admitted as an inpatient.
Does Medicare Cover Rehabilitation After Hip Replacement?
Recovery from hip replacement surgery almost always involves rehabilitation, and Medicare covers it — but the type of coverage depends on your setting.
Inpatient Rehabilitation and Skilled Nursing Facility (SNF) Coverage
If you need intensive rehabilitation after your hospital stay, Medicare Part A may cover transfer to an inpatient rehabilitation facility or skilled nursing facility. Requirements include:
- A qualifying inpatient hospital stay of at least 3 consecutive days (not observation status)
- Transfer to a Medicare-certified SNF within 30 days of discharge (usually)
- Care must be medically necessary and ordered by your physician
Coverage under Part A for SNF care works as follows:
- Days 1–20: Medicare pays 100% — you pay $0 (after your Part A deductible for that benefit period)
- Days 21–100: You pay daily coinsurance ($209.50/day in 2025)
- Day 101 and beyond: You pay all costs — Medicare stops covering SNF care
Outpatient Physical and Occupational Therapy
Most hip replacement patients receive outpatient physical therapy as part of their recovery. Medicare Part B covers medically necessary outpatient therapy with no annual visit limit — as long as your doctor continues to certify the need. You pay 20% of the Medicare-approved amount after your Part B deductible.
Home Health Services
If you are homebound after surgery and require intermittent skilled nursing or therapy, Medicare covers home health services. These include nursing visits, physical therapy, occupational therapy, and speech-language pathology services provided in your home. To qualify, your doctor must certify that you are homebound and order a plan of care.
Does Medicare Cover Equipment After Hip Replacement?
Yes. Medicare Part B covers durable medical equipment (DME) that your doctor prescribes to support your recovery. Covered equipment typically includes:
- Walkers and wheeled walkers
- Crutches
- Canes
- Wheelchairs or transport chairs (if medically necessary)
- Raised toilet seats and grab bars in some circumstances
You pay 20% of the Medicare-approved amount for DME after your Part B deductible. Make sure the equipment supplier is enrolled in Medicare and accepts assignment to avoid excess charges.
Does Medicare Advantage Cover Hip Replacement?
Medicare Advantage (Part C) plans are required by federal law to cover at least everything Original Medicare Parts A and B cover, including hip replacement surgery. In practice, most Advantage plans provide comparable or better coverage with additional financial protections.
Key advantages of Medicare Advantage for hip replacement:
- Annual out-of-pocket maximum: Original Medicare has no cap on what you can owe in a year. Medicare Advantage plans must include an annual out-of-pocket maximum, providing a financial ceiling on your exposure.
- Lower cost-sharing in many plans: Some Advantage plans offer lower copays for surgery than Original Medicare’s 20% coinsurance.
- Bundled additional benefits: Many Advantage plans include dental, vision, hearing, and fitness benefits not available in Original Medicare.
The trade-off: Medicare Advantage plans use provider networks. Make sure your surgeon and the surgical facility are in-network before scheduling, or you may face significantly higher costs or denial of coverage.
How Medigap (Medicare Supplement) Can Reduce Your Hip Replacement Costs
For beneficiaries on Original Medicare, a Medigap (Medicare Supplement) policy can substantially reduce or even eliminate out-of-pocket costs for hip replacement surgery. Medigap plans are sold by private insurers and are standardized by federal law.
| Plan | Part A Deductible Covered? | Part B Coinsurance Covered? | Part B Deductible Covered? |
|---|---|---|---|
| Plan G | ✅ Yes | ✅ Yes | ❌ No |
| Plan N | ✅ Yes | ✅ Yes (with copays) | ❌ No |
| Plan F (pre-2020 enrollees only) | ✅ Yes | ✅ Yes | ✅ Yes |
With a Plan G policy, for example, you would only owe the Part B annual deductible ($268 in 2026) for an outpatient hip replacement — Medigap covers the rest. For inpatient surgery, Plan G covers the entire Part A deductible, leaving you with nothing additional to pay for the hospital stay itself.
What Medicare Does Not Cover for Hip Replacement
Even with comprehensive Medicare coverage, some costs remain your responsibility:
- Elective or cosmetic procedures: Hip replacement without documented medical necessity is not covered
- Private hospital rooms: Medicare covers semi-private rooms; upgrades are your expense
- Personal comfort items: Television, telephone service, and similar amenities are not covered
- Long-term custodial care: After your SNF benefit is exhausted (day 101+), ongoing custodial or nursing home care is not covered by Medicare
- Out-of-network providers (Advantage plans): If your surgeon or facility is outside your plan’s network, you may owe significantly more
- Non-participating provider excess charges: Providers who don’t accept Medicare assignment can charge up to 15% above the approved amount
How to Prepare for Hip Replacement Surgery with Medicare
A few proactive steps before your procedure can prevent financial surprises:
- Confirm medical necessity documentation. Ask your surgeon to document failed conservative treatments and the clinical basis for surgery in your medical record before the procedure is scheduled.
- Clarify inpatient vs. outpatient status. Ask your surgeon and hospital directly whether you will be formally admitted as an inpatient. This determines whether Part A or Part B applies and whether you’ll qualify for SNF rehabilitation coverage.
- Verify Medicare assignment. Confirm that your surgeon, anesthesiologist, and facility all accept Medicare assignment so you’re not subject to excess charges.
- Review your Medigap or Advantage plan benefits. If you have a Medigap policy, pull out your plan documents and confirm what it covers. If you have Medicare Advantage, check your Summary of Benefits and confirm your providers are in-network.
- Plan your rehabilitation in advance. If you expect to need SNF or inpatient rehabilitation, confirm that your facility choice is Medicare-certified and that your hospital stay will meet the 3-night qualifying stay requirement.
- Get an Advance Beneficiary Notice (ABN) if uncertain. If your provider thinks Medicare might not cover a specific service, they are required to give you an ABN in advance so you can decide whether to proceed and understand your financial responsibility.
Frequently Asked Questions
Does Medicare cover hip replacement surgery?
Yes. Medicare covers hip replacement surgery when a doctor certifies it is medically necessary. Medicare Part A pays for inpatient hospital costs, and Part B pays for outpatient surgery and physician fees. You must meet eligibility criteria including failed non-surgical treatments and documented joint disease.
How much does hip replacement surgery cost with Medicare?
With Original Medicare in 2026, an inpatient hip replacement typically costs the Part A deductible of $1,736 for the hospital stay. For outpatient surgery, you pay the $268 Part B deductible plus 20% coinsurance, which averages $2,000 to $2,100 out-of-pocket. A Medigap supplement plan can dramatically reduce or eliminate these costs.
What are the Medicare eligibility requirements for hip replacement?
Medicare requires that the surgery be medically necessary. This typically means imaging or clinical evidence of advanced joint disease; a history of failed non-surgical treatments; significant pain and functional disability; structural joint abnormalities; or a failed prior replacement. Purely elective or cosmetic hip replacements are not covered.
Does Medicare cover rehabilitation after hip replacement?
Yes. Medicare Part A covers inpatient rehabilitation and skilled nursing facility stays for up to 100 days per benefit period following a qualifying 3-night hospital admission. Medicare Part B covers outpatient physical and occupational therapy with no annual visit limit, as long as care is medically necessary.
Does Medicare Advantage cover hip replacement?
Yes. Medicare Advantage plans are required by law to cover at least what Original Medicare Parts A and B cover. Most Advantage plans also include an annual out-of-pocket maximum, which limits your total financial exposure in a way that Original Medicare does not.
Can Medicare cover same-day outpatient hip replacement?
Yes. When hip replacement is performed on an outpatient basis, Medicare Part B covers the procedure. You pay the annual Part B deductible plus 20% coinsurance. Patients over 85 or those with complex medical conditions are typically still recommended for inpatient admission.
Does Medicare cover durable medical equipment after hip replacement?
Yes. Medicare Part B covers medically necessary equipment prescribed by your doctor, including walkers, crutches, canes, and wheelchairs. You pay 20% of the Medicare-approved amount after your Part B deductible.
The Bottom Line
Medicare does cover hip replacement surgery — and in most cases, it covers it well. The key is understanding how the coverage works before you’re in the middle of the process. Whether your surgery is inpatient or outpatient, with Original Medicare or a Medicare Advantage plan, knowing what you’ll owe ahead of time lets you plan, compare supplemental options, and avoid the billing surprises that catch many Medicare beneficiaries off guard.
If you’re approaching Medicare enrollment or weighing your current plan options, comparing Medigap and Medicare Advantage plans in your area is a smart first step. A policy that covers your Part A deductible and Part B coinsurance could reduce your out-of-pocket cost for a hip replacement from several thousand dollars to near zero.
This article is for informational purposes only and does not constitute medical or insurance advice. Medicare rules and costs change annually. Always verify current figures with Medicare.gov or a licensed Medicare counselor before making coverage decisions.
