Everyone knows that the body begins to ache more as we age. These pains are particularly common in the joints, specifically the hips. For some, these pains can become severe enough to inhibit normal functions such as walking, getting up and down, or even using the bathroom. For those people who find themselves in this level of discomfort, a hip replacement might be a good idea. However, those with Medicare may be curious whether their insurance covers the procedure.
The answer is, often, yes, so long as the procedure is a medical necessity. However, when determining which Medicare part to utilize for coverage, the answer isn’t always straightforward. Read on to learn more.
Medicare Part C
Medicare Part C, also known as Medicare Advantage, covers the same things that Original Medicare covers. Therefore, Part C also covers hip replacements.
As with Original Medicare, Medicare Advantage covers MRIs and X-rays, surgery costs, Doctors visits, and any physical therapy needed after the hip replacement.
Some Medicare Advantage plans also come with the drug portion of Medicare bundled together. They’ll also include meal delivery to the patient’s home and non-emergency medical transport to medical appointments.
Medicare Part D
Medicare Part D is the drug coverage portion of Medicare. Because it specializes in drugs, Medicare Part D does not cover hip replacement on its own. However, Medicare Part D does cover whatever therapies are needed to treat the patient after the procedure.
Part D covers medications that aren’t covered by Original Medicare but that the patient needs during recovery. The medications can include items for pain management and blood thinners to prevent clotting. This part also covers anti-inflammatories and antibiotics if the patient needs them.
Medigap
Because Medigap provides coverage for copays and additional medical payments, it does not cover hip replacement on its own.
A patient with Medigap could expect the supplement to pay for the deductible associated with both parts of inpatient and outpatient care. Medigap coverage would also pay the 20% coinsurance price that makes up the out-of-pocket portion of Part B.
How Much Does Medicare Pay for the Surgery?
How much a patient will have to pay out of pocket depends on their chosen plans, surgery costs, and whether the procedure is part of an inpatient or outpatient surgery. However, keep in mind that Medicare Part A covers inpatient procedures. If using Medicare Part A to cover a hip replacement, the patient can expect to pay $1,600 out of pocket to cover their deductible before the insurance covers the rest.
If the procedure is part of an outpatient plan, Medicare Part B will cover 20% of the procedure cost after the patient pays the Part B $226 deductible. Medigap may pay more of the patient’s out-of-pocket costs, but that depends on the plan the patient has selected.
Does Medicare Cover Hip Injections?
Platelet-rich plasma injections and stem cell injections are two injection types that Medicare covers. Because Medicare and Medicare-certified physicians want to do the least invasive treatments first, they’ll recommend hip injections as a part of the medication and physical therapy plan. If these options don’t work, they’ll explore the surgical route of pain relief.
Does Medicare Cover Cortisone Shots?
A cortisone shot is a cocktail of liquid steroids, pain relievers, or other anti-inflammatory drugs. A patient experiencing pain in a particular joint can receive an injection directly into the joint for fast pain relief. Patients who receive a cortisone injection can usually get it from their doctor’s office and are permitted to go home the same day. Because this shot treats inflammation directly, Medicare Part B will typically cover 80% of the treatment costs after the patient has met their deductible.