Does Medicare Cover Knee Replacement?

Unfortunately, as we get older, our bodies begin to get worn down and a little rusty. This wearing takes its toll on all parts of the body, but nowhere is this more prominent than on the joints. However, there is one part of your body that struggles more than most with the aging process, and that joint is the knee. As such, many people will need to get a knee replacement at some point in their lives, but if you are a pensioner, does Medicare cover the cost of a knee replacement?

Or will you have to find another source of income to deal with it?

What is a Knee Replacement?

A knee replacement is an operation where the cartilage in both knees is removed and replaced with a synthetic implant.

The cartilage is the weight-bearing part of the knee joint, and replacing them is done to ease pain and help with disabilities.

This is done when conventional or common methods of easing said pain have failed to help or stop it and when arthritis – either rheumatoid or psoriatic – has advanced to a debilitating state.

The knee replacement is the most common procedure that people over the age of 65 will be getting on their knees and one of the most common procedures for that age group.

Knee replacements are only performed when every single treatment has been exhausted and the patient remains in a great deal of pain.

This often happens because the cartilage in the knee has worn away completely and there is no other way for the patient to continue living a normal, pain-free life.

There are two types of knee replacement: full and partial, with most people having a full knee replacement.

The knee is divided into three compartments: medial, patellofemoral, and lateral, with the medial being the compartment that needs replacing most commonly.

Partial knee replacements are cheaper, and while most people have to replace the whole knee, some people have the option for a partial knee replacement.

However, they do have the highest amount of revision surgeries.

Knee replacement often uses metal or plastic components to rebuild the knee, and the operation of rebuilding an entire section of the body is intense, to say the least.

Many people require months before they are able to walk without mobility aids.

While knee replacements are expected to last 25 years or so, they can break sooner and there are only so many knee replacements a person can get.

Does Medicare Cover a Knee Replacement?

As with all medical insurance in the US, it is an answer with some caveats, basically a: ‘yes, but…’ answer.

Knee replacements are considered a surgery and a major one at that. As such, Medicare will cover it only if it is deemed medically necessary for your situation.

Therefore, if your doctor deems it medically necessary for you, then you will be covered by Medicare. If it is not deemed medically necessary, then it will not be covered.

While this may be excellent news for some people, it will also require more digging to see whether you are actually covered.

See, Medicare is broken up into 4 different types of medical coverage: Part A, B, C, and D.

Part D only covers prescription drug plans for self-administered drugs, so while this will not affect your knee replacement.

It may affect post-operative care outside the hospital. So make sure that your version of this plan covers your post-operative medicine.

Part A will cover you if you have an inpatient knee replacement procedure and Part B will cover you if you have an outpatient knee replacement procedure, but you need to make sure that if you have Part B as it is optional.

Part C is what’s called an ‘Medicare Advantage Plan’. It often has different rules and services based on the plan and the policyholder.

If you have this plan, please check with your Medicare provider whether a knee replacement is covered or not.

Unfortunately, your costs for a knee replacement will change depending on what plan you have. Even if you are completely covered, you will likely incur other costs, from co-insurance to deductibles.

This means that you will likely still be paying a high price for your new knee.

How Much Will it Cost without Insurance?

Brace yourselves. A total knee replacement costs $50,000 without any insurance. That number is also just an average number across the US.

You could pay thousands more or thousands less. But we can guarantee that even the cheapest will not go below $20,000.

Even if you want a partial knee replacement, the number is generally only about 10% to 20% less than a total knee replacement.

These numbers are only for the surgery as well. Not the other parts of care or services that you undoubtedly are charged for as well.

As such, we think it would be wise to try and improve things on your own before seeking surgery. Or at least improve things while saving for surgery.

Knees wear down because they are holding up great weights. This isn’t to say that everybody who has knee surgery is overweight. It’s just that the human body is heavy in general.

One of the best things you can do is to improve your fitness and lose weight. That way you can manage your knee pain. It may seem simple, but losing even a few pounds can reduce the ache and swell of your knee joint.

Going for gentle walks can help as well. Even though the knee is being moved, fluid that causes swelling in the knee is also being moved out of it, reducing the swelling and as such your pain.

Conclusion

Medicare does pay for knee replacements, depending on the plan you have. But they will not necessarily pay for all the costs.

As such, if you need a knee replacement or are going to need a knee replacement, it would be best to plan for it a couple of years in advance. Try to make the wear on your knee lessen through diet and exercise.

Frequently Asked Questions