Medicare and Knee Replacement Surgery

Jun 10th, 2017     Medicare

Knee Replacement surgery is among the most common surgeries for people who are 65 and above. Medicare Part A and Part B cover different portions of this procedure and post-surgery care when it is medically necessary as suggested by the doctor.

To find out the list of orthopedic surgeons who are enrolled with medicare, refer to our website //

Cost for Knee Replacement surgery

For surgeries or procedures, it’s difficult to estimate costs in advance because no one knows what kind of service is needed for the patient. If he/she is having surgery or a procedure, he/she can do some things in advance to figure out approximately how much he/she will have to pay.

  • Ask the doctor, hospital, or facility how much the patient has to pay for the surgery and any care afterward.
  • Make sure the patient knows if he/she is an inpatient or outpatient because costs may vary accordingly.
  • Check with any other insurance the patient may have (like a Medicare Supplement Insurance (Medigap) policy, Medicaid, or coverage from his/her or spouse’s employer) to see what it will pay. If the patient belongs to a Medicare health plan, contact his/her plan for more information.
  • Check his/her Part A deductible if he/she expects to be admitted to the hospital.
  • Check his/her Part B deductible for a doctor’s visit and other outpatient care.
  • Patient needs to pay the deductible amounts before Medicare will start to pay. After Medicare starts to pay, he/she may have copayments for the care he/she gets.

Original Medicare Coverage for Knee Replacement surgery

Any inpatient stay associated with a knee replacement surgery is covered under Medicare Part A. Any outpatient care associated with a knee replacement surgery is covered under Medicare Part B. However, the patient has to pay the Medicare Part A and Part B deductibles and co-payments (if any).

Other costs associated with Knee Replacement Surgery

The other costs that might be included is that of any prescription medications that the doctor might prescribe such as painkillers, anticoagulants, or antibiotics. Medicare Part A covers the prescription drugs during the inpatient stay. Medicare Part B covers the prescription drugs associated when the patient is given outpatient services.

Medicare Part D Prescription Drug Plan may help cover the patient’s prescription drugs, although not every prescription drug is covered under every plan. Medicare prescription drug plans maintain their own lists of covered drugs.

How to limit expenses associated with Surgeries covered under Medicare

Medicare Supplement insurance (for limiting out-of-pocket expenses) and a stand-alone Medicare Part D Prescription Drug Plan (for prescription drugs) are the options to be considered for overall reduction in expenses if the person is enrolled in Original Medicare. The other option is to get a good Medicare Advantage plan which covers prescription drugs (sometimes called MA-PD) and also have limit on maximum out-of-pocket expenses.

If you have any questions, please post a comment below and we will be happy to answer.

Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.