What Your Insurance Covers for Hip or Knee Replacement
Know what to expect from your policy before your surgery
If you’re a senior considering a knee replacement or hip replacement, your first concerns may be how much the procedure will cost, what your insurance will cover, and what you may have to pay out-of-pocket.
Even though knee and hip replacements are the most common types of surgeries for Medicare enrollees, Medicare may not cover all aspects of your knee replacement or hip replacement surgery. In general, Medicare won’t cover joint replacement unless other, less-invasive treatments prescribed by your doctor have not been successful in improving your ability to walk without stiffness and pain, whether it’s due to arthritis or injury.
If your doctor does determine that joint replacement is the best course of action for you, the good news is that the American Academy of Orthopaedic Surgeons says total knee replacement and total hip replacement surgeries are safe and effective. The complication rate is very low and after physical therapy, you will likely have a positive outcome.
But these procedures don’t add up to a better quality of life overnight. Your total care plan will require:
- a period of hospitalization
- prescription medications, such as painkillers, anticoagulants, and antibiotics
- medical equipment rental, like a walker to help you get around at first
- a comprehensive recovery plan, including physical therapy
Medicare Parts A and B cover different aspects of these procedures, from evaluation tests to your hospital stay, but it’s likely that until you’ve met your deductible for both parts, most of your joint replacement surgery will not be covered. Talk to your doctor about your specific treatment needs, so you can understand all costs involved, from recovery to prescription drugs. Then find out what specifically your Medicare plans will cover. For example, the Medicare Part D Prescription Drug Plan may help pay for medications.
To fill in the gaps between your Medicare coverage and out-of-pocket costs associated with knee replacement or hip replacement surgery, you may want to consider purchasing a Medicare supplement plan. Also known as a Medigap policy, a Medicare supplement plan can help pay deductibles, copayments, outpatient care, and physical therapy that will be required following a knee replacement or hip replacement surgery.
Medico’s Medicare Supplement plans don’t include a pre-existing condition waiting period, and prior medical conditions are covered as soon as your policy is effective. They provide the freedom to choose any doctor or hospital that accepts Medicare, so you don’t need to worry about finding network providers or getting referrals to see joint replacement specialists. The plans are also guaranteed renewable for life, so your coverage will never be canceled, even if your health changes.
If you already have a Short-Term Recovery Care insurance plan, it may help cover your hip replacement or knee replacement surgery if it’s a result of an unexpected accident or injury. Keep in mind, this type of policy won’t cover a pre-existing condition, so it wouldn’t make sense to purchase a plan if you already have a joint replacement surgery scheduled.
Medico’s Short-Term Recovery Care policy covers a short stay of 12 months or less in a nursing home or assisted living facility. It also covers home health care, but you would have to prove that you require assistance. If you’re only able to perform two out of six daily living activities — toileting, continence, bathing, transferring from a chair or bed, eating, and dressing — after your joint replacement surgery, you may qualify for coverage.
No matter what type of insurance you have or may be looking to buy, keep in mind that coverage depends on your state of residence and your individual circumstances.
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Photo credit: iStock/Fred Froese