Medigap Coverage for Hip and Knee Replacement
Joint replacement is one of the most common surgeries for people over 65. Medicare covers it — but the out-of-pocket costs without supplemental coverage can reach $8,000 or more.
What Medicare covers
Medicare covers joint replacement surgery when medically necessary: the hospital stay, surgeon fees, anesthesia, the prosthetic joint, post-surgical rehabilitation, and physical therapy. It also covers pre-operative imaging and lab work.
What you pay without Medigap
| Item | Total cost | Your share (no Medigap) |
|---|---|---|
| Hospital stay (2-3 days) | $20,000 - $30,000 | $1,676 (Part A deductible) + 20% of remaining |
| Surgeon and anesthesia fees | $8,000 - $15,000 | 20% = $1,600 - $3,000 |
| Implant (prosthetic joint) | $5,000 - $12,000 | Included in hospital charges |
| Physical therapy (6-12 weeks) | $3,000 - $6,000 | 20% = $600 - $1,200 |
| Pre-op imaging and lab work | $500 - $1,500 | 20% = $100 - $300 |
Total out-of-pocket without Medigap
$4,000 - $8,000+
Total out-of-pocket with Plan G
$283
Part B deductible only
Planning ahead
If you know you'll need a hip or knee replacement in the next few years, enrolling in Medigap during your Open Enrollment Period is especially important. Even one joint replacement will generate costs that exceed several years of Plan G premiums.
If you're considering surgery before age 65, talk to your surgeon about timing. Having the procedure after your Medicare and Medigap coverage starts could save thousands.
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