Does Medicare Cover Knee Replacement Surgery?

Knee replacement is a common and life-changing surgery that can ease chronic pain and improve movement. Each year, over 790,000 people in the U.S. have this procedure.

If you have Medicare, knowing what’s covered can help you plan and avoid surprise costs. This guide explains what’s included, which parts of Medicare apply and how to get ready—medically and financially.

When Does Medicare Cover Knee Replacement?

Medicare covers knee replacement surgery when it’s medically necessary. That means your doctor must decide that the surgery is essential for your health and that other options like medication or physical therapy haven't worked.

Coverage usually applies if you have:

• Severe pain from arthritis or joint damage
• Trouble walking, standing, or doing daily tasks
• Pain while resting

Medicare does not cover elective knee replacements for cosmetic reasons or when pain or mobility issues are not clearly documented.

Which Parts of Medicare Cover Knee Replacement?

Several parts of Medicare may apply to your surgery, depending on where it’s performed and the type of care you need before and after.

Medicare Part A (Hospital Insurance)

If your knee replacement is done inpatient, Medicare Part A covers:

• Your hospital room, meals and nursing care
• Post-operative hospital services, such as labs or imaging
• A semi-private room and any medically necessary hospital supplies

You’ll pay your deductible in 2025. After that, how much you owe depends on how long you’re in the hospital

Medicare Part A may also cover short-term Skilled Nursing Facility (SNF) care if:

• You had a qualifying three-day inpatient hospital stay
• You need rehab after surgery

SNF costs are:

• Days 1—20: $0
• Days 21—100: Daily coinsurance applies (20%)
• After Day 100: You pay all costs

Medicare Part B (Medical Insurance)

If your surgery is outpatient, Part B covers:

• Surgeon and anesthesiologist fees
• Pre- and post-op doctor visits
• Outpatient physical and occupational therapy
• Durable medical equipment (DME) like a walker or raised toilet seat
• Outpatient facility where the surgery takes place

In many cases, Medicare covers outpatient knee replacement surgery in ambulatory surgical centers (ASCs). These facilities often cost less than hospitals and may offer a faster recovery experience.

Part B Costs in 2025:

• Monthly premium: $185
• Annual deductible: $257
• Coinsurance: 20% of the Medicare-approved amount after the deductible

Medicare Advantage (Part C)

Medicare Advantage (Part C) is an alternative to Original Medicare, not an add-on. When you enroll in a Medicare Advantage plan, it replaces Part A and Part B coverage. You can’t have both at the same time.

Part C must cover everything that Original Medicare covers, including knee replacement. Some also offer extra benefits that help with recovery, like:

Some plans may offer:

• Lower out-of-pocket costs
• Transportation to surgery or therapy
• Home-delivered meals or in-home rehab

However, each plan is different. Be sure to:

• Check if your surgeon and facility are in-network
• Ask if you need prior approval

Review what recovery services your plan includes

Medicare Part D (Prescription Drug Coverage)

After knee replacement surgery, you may be prescribed:

• Pain medications
• Blood thinners
• Antibiotics

These drugs are not covered under Part A or B, but Part D can help if the medications are listed on your plan’s approved drug list (formulary).

You can get Medicare drug coverage in two ways:

• With Original Medicare: Add a standalone Part D plan
• With Medicare Advantage: Enroll in a Medicare Advantage plan that includes drug coverage (MAPD), which combines medical and prescription benefits in one plan

Make sure to always check with your provider or pharmacist to make sure your medications are covered before filling a prescription.

What Affects the Cost of Knee Replacement Surgery?

The total cost of your knee replacement depends on many personal and medical factors.

Personal Factors

• Location: Costs vary by state, city or rural vs. urban setting
• Facility type: Hospitals may cost more than outpatient surgery centers
• Health conditions: Chronic illnesses or obesity may increase costs or length of stay

Medical/Surgical Factors

• Surgical time and operating room costs
• Type of implant or materials used
• Anesthesia type and duration
• X-rays and imaging before and after
• Medications for pain or infection prevention
• Complications or additional care needs
• Length of inpatient stay
• Amount of therapy needed during recovery

Medicare helps cover many of these costs, but you may still be responsible for deductibles, coinsurance and services not covered under your plan.

Preparing for Knee Replacement Surgery

Getting ready for surgery ahead of time can help lower your costs, support recovery and reduce the risk of complications.

Health Preparation

• Quit smoking at least 2–3 weeks before surgery to help healing.
• Eat well and follow your doctor’s nutrition advice to build strength.
• Lose weight if recommended as it can ease pressure on your new knee.

Choosing a Surgeon and Facility

• Look for a provider with experience treating Medicare patients.
• Ask for cost estimates so you’re not surprised by bills.
• If you have Medicare Advantage (Part C), use an in-network surgeon and facility. If you have Original Medicare, confirm Medicare is accepted.

Planning for Recovery

• Make your home safer with grab bars, clear walkways and raised seating.
• Schedule physical therapy in advance. Part B usually covers 80% after the deductible. Medicare Advantage plans may have different rules or limits.
• As if you’ll need home health care or a Skilled Nursing Facility stay, and check what your plan covers.

Post-Surgery Coverage and Costs

Medicare helps with more than just the surgery, it also covers follow-up care, therapy and equipment to support your recovery.

• Follow-up doctor visits (like wound checks and post-op care) are covered under Part B.
• Outpatient therapy, such as physical or occupational rehab, is also covered under Part B (20% coinsurance applies after deductible), typically Medicare Part B covers up to 15 visits per year unless more are medically necessary.
• Durable medical equipment (DME) like walkers, crutches or bathroom safety tools are covered under Part B and, with a doctor’s prescription.

If you need additional recovery care in a Skilled Nursing Facility (SNF):

• Covered under Part A, but only after a qualifying three-day inpatient hospital stay
• Days 1–20: $0
• Days 21–100: Coinsurance applies (check current rates)
• After 100 days: You pay all costs

Medications taken after discharge are covered under Part D if included in your plan’s drug list. Always check with your pharmacist or plan provider before filling a new prescription.

Helpful Resources

• Call Medicare: 1-800-MEDICARE (800-633-4227)
• Visit: medicare.gov
• Talk to your Medicare Advantage plan provider for network-specific details and post-op care options.

Your Medicare Coverage, at a Glance

Medicare does cover knee replacement surgery when your doctor determines it is medically necessary. Whether it’s performed inpatient or outpatient will determine which parts of Medicare apply.

Here’s a quick recap:

• Part A covers hospital stays and short-term SNF care.
• Part B covers outpatient procedures, doctor visits, therapy and equipment.
• Part C (Medicare Advantage) includes everything Parts A and B cover and may offer extra benefits like lower copays, in-home recovery support or transportation.
• Part D helps cover prescriptions after surgery.

Understanding your options helps you prepare—physically, financially and emotionally—for a successful recovery.

Frequently Asked Questions (FAQs) About Medicare Coverage of Knee Replacement Surgery

Is there an age limit to get Medicare to cover a knee replacement surgery?

No. Medicare does not impose an age limit. The surgery must simply be medically necessary and approved by your doctor.

How much does knee replacement surgery cost with Medicare?

Costs vary based on your location, health condition and whether the procedure is inpatient or outpatient. Expect your Part A or Part B deductible, plus 20% coinsurance under Part B. Medicare Advantage plans may offer lower or capped out-of-pocket costs.

Is knee replacement considered inpatient or outpatient surgery?

It can be either. As of 2018, Medicare approves outpatient knee replacements, but many are still performed inpatient. The surgery location affects whether Part A or Part B applies.

How can I find out what my Medicare Advantage plan will pay for surgery?

Contact your plan provider before surgery. They can confirm coverage, estimated out-of-pocket costs and whether prior authorization is required. Costs and benefits vary, so it’s important to check your plan details ahead of time.

What extra benefits might Medicare Advantage offer that Original Medicare doesn't?

Medicare Advantage plans must cover everything that Original Medicare covers, but they may also offer extra benefits. These can include lower out-of-pocket costs, transportation to therapy, meal delivery or in-home rehab after surgery.

Note: Benefits vary by plan and location, so check with your provider to confirm what’s included in your specific plan.

Sources

• Medicare.gov: 2025 Medicare costs
• orthoinfo.aaos.org: Total Knee Replacement
• Medicare.gov: Surgery
• Medicare.gov: Skilled nursing facility care
• medicalnewstoday.com: Does Medicare cover knee replacement?
• cms.gov: 2025 Medicare Parts A & B Premiums and Deductibles
• ehealthinsurance.com: Does Medicare Cover Knee Replacement Surgery Costs?
• Uhc.com: Does Medicare cover knee replacement surgery?
• healthgrades.com: Does Medicare Cover Knee Replacement? Coverage Explained
• ABShealthinsurance.com: Does Medicare Cover Knee Replacement Surgery?
• healthline.com: Understanding What Medicare Covers for Knee Replacement Surgery

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