Does Medicare Cover Knee Replacement Surgery?

Knee replacement surgery is a life-changing procedure for seniors managing severe arthritis, joint degeneration, or injury. Understanding the coverage landscape before scheduling — including which Medicare part pays, what rehab options are available, and what you’ll owe — lets you make decisions with confidence rather than anxiety.

1. Inpatient vs. Outpatient: Which Applies to You?

This is the most financially significant question for knee replacement coverage, and it’s been shifting rapidly. In 2018, Medicare removed total knee replacement from its “inpatient-only” list — meaning surgeons can now perform the procedure in a hospital outpatient department or ambulatory surgical center (ASC) and bill under Part B rather than Part A.

Whether your surgery is inpatient or outpatient is a medical and logistical decision made by your surgeon and hospital—factors include your overall health, anesthesia risk, living situation, and surgical facility capabilities. Patients with significant comorbidities (heart disease, obesity, diabetes, COPD) are more likely to be admitted as inpatients for monitoring.

2. What Knee Replacement Costs Under Medicare in 2026

3. What Medicare Covers Before, During & After Surgery

4. Rehab After Knee Replacement: All Your Coverage Options

Recovery from knee replacement is largely a physical therapy story—and Medicare covers rehab through multiple pathways depending on your condition and setting immediately after surgery.

Option 1: Inpatient Rehabilitation Facility (IRF)

If your surgeon determines you need intensive inpatient rehab (at least 3 hours of therapy per day, 5 days per week), you may be admitted to an inpatient rehabilitation facility. Medicare Part A covers IRF care under the same hospital benefit period rules: $1,736 deductible covers days 1–60, then daily coinsurance applies. To qualify, you must have a 3-day inpatient hospital stay (not observation status) before the IRF admission.

Option 2: Skilled Nursing Facility (SNF)

For patients who need daily skilled nursing or physical therapy but don’t qualify for or need the intensity of an IRF, a skilled nursing facility rehab stay is an option. Medicare Part A covers up to 100 days per benefit period: days 1–20 at $0 and days 21–100 at $217/day coinsurance. Again, a qualifying 3-day inpatient hospital stay is required.

Option 3: Home Health Physical Therapy

For patients who are homebound after surgery, Medicare covers home-based physical therapy at 100% through the home health benefit — no deductible, no coinsurance. A doctor must certify you are homebound and need skilled PT. This is increasingly the preferred option for outpatient knee replacement patients who can’t safely drive to a clinic immediately post-surgery.

Option 4: Outpatient Physical Therapy

Once you can safely travel, outpatient PT at a clinic or hospital is covered under Part B at 80% after the deductible. For most knee replacement patients, outpatient PT becomes the primary rehab modality after the first 2–6 weeks. There is no annual limit on covered PT as long as it is medically necessary.

5. Does Medicare Cover Partial Knee Replacement?

Yes. Partial knee replacement (unicompartmental knee arthroplasty) — which replaces only the damaged compartment of the knee rather than the entire joint — is covered under the same Medicare rules as total knee replacement. The procedure is less invasive, often performed entirely as an outpatient, and covered under Part B with the same 20% coinsurance structure.

6. How to Reduce Your Out-of-Pocket Costs

• Medigap Plan G: The most comprehensive plan available to new Medicare enrollees. Covers your 20% Part B coinsurance after your annual deductible, potentially saving $3,000–$5,000 on knee replacement surgery alone. If you are approaching the need for joint replacement and don’t have Medigap, enrollment during your Medicare Supplement Open Enrollment Period (the 6 months after you first enroll in Part B) guarantees acceptance regardless of pre-existing conditions.
• Medicare Advantage out-of-pocket maximum: Medicare Advantage plans have an annual out-of-pocket maximum (no more than $9,250 for in-network care in 2026). If your surgery and rehab costs reach that cap, all further in-network covered care is free for the rest of the year.
• Ambulatory Surgical Centers vs. Hospital Outpatient Departments: ASC facility fees are typically 40–60% lower than hospital outpatient department rates—and your 20% coinsurance is 20% of those lower rates. If your surgeon operates at both, ask about the cost difference.
• Confirm all providers accept Medicare assignment: Your surgeon, anesthesiologist, and facility should all accept Medicare assignment. A non-participating provider can charge up to 15% above the Medicare-approved rate, adding to your bill.

7. Frequently Asked Questions

Does Medicare cover bilateral knee replacement (both knees at once)?

Simultaneous bilateral knee replacement (both knees in one surgical session) is covered by Medicare when medically appropriate, though it is less common due to higher complication risk. Staged bilateral replacement (each knee in a separate surgery) is also covered. Each procedure follows the same cost-sharing rules — if done in the same year, your annual deductible applies only once.

Does Medicare cover a knee brace before or instead of surgery?

Yes. Medicare Part B covers medically necessary knee braces as durable medical equipment at 80% after the deductible. An unloader brace for osteoarthritis, prescribed by a physician, qualifies. This may be a non-surgical option for some patients, and Medicare covers it while that determination is being made.

Does Medicare cover knee replacement revision surgery?

Yes. Revision knee replacement — replacing a failed or worn implant — is covered under the same Medicare rules as primary knee replacement when medically necessary. Revision surgeries are more complex and typically take longer, which may affect cost-sharing amounts.

Does Medicare cover robotic-assisted knee replacement?

Medicare covers the knee replacement procedure itself regardless of whether robotic assistance is used, as long as the procedure is medically necessary and performed by a qualified surgeon. The robotic system is a surgical tool, not a separate billed service. However, some facilities charge a “technology fee” for robotic assistance — ask your facility whether any such fee is billed separately and whether it is covered by Medicare.

How long is recovery from knee replacement on Medicare?

Recovery typically takes 3–6 months to return to full activity, with most patients driving within 4–6 weeks and returning to light activity within 6–12 weeks. Medicare continues to cover medically necessary physical therapy throughout this recovery period as long as your therapist documents ongoing functional improvement.

This article is for informational purposes only. Medicare cost-sharing amounts change annually. The inpatient vs. outpatient classification of your surgery is a medical determination made by your surgeon and facility, not a choice you make. Verify any cost figures at Medicare.gov or call 1-800-MEDICARE.