Does Medicare Cover Knee Replacement: Here’s What You Need To Know

Does Medicare cover knee replacement? Yes. In an unfortunate event when a patient needs knee replacement surgery, they often ask, ‘Does Medicare cover knee replacement surgery, how does it work with this type of procedure? A knee replacement is a common yet complex process requiring months of preparation before replacement and care after the surgery. Understanding Medicare coverage knee replacement, equipment, and rehab that covers post-replacement will make the process easier for you.

This blog will explain everything that needs to be understood about Medicare and knee replacement surgery.

What is Knee Replacement? Why Do You Need Knee Replacement?

A knee replacement, also known as a total knee replacement or arthroplasty, is a surgical process used to replace injured or worn-out knee parts. It helps to improve mobility, reduces pain in the knee joints, and is recommended by doctors when other methods have failed to provide any relief.

As we age, the joints go through some generative changes which affect our mobility. The wear and tear in our knees may be exacerbated due to an injury or obesity. When a severe injury strikes the knee either due to an accident or while playing, it can incredibly limit knee movement.

Fortunately, knee replacement surgery is successfully helping people to recover from knee injuries by allowing them to go under minimally invasive surgery with permanent knee parts replacement. This is especially a great opportunity for old Americans who suffer from mobility issues and fail to live a good quality life due to knee pain.

If you’re in need of knee replacement surgery, you should know that it’s quite expensive and might cost you $50,000 on average without insurance. However, if you’re a Medicare beneficiary, it might cover the total cost of your knee replacement surgery if deemed medically necessary.

Does Medicare Cover Knee Replacement Surgery 100%?
One of the major concerns of senior citizens and other qualified Medicare recipients is “How much cost does Medicare cover??

Medicare covers the total knee replacement surgery if deemed medically necessary by your healthcare provider. However, different parts of knee surgery are covered under different parts of Medicare coverage. Depending on the type of knee surgery you get, the treatment may be covered under Part A or Part B of Medicare coverage.

Part A Coverage

Part A covers inpatient knee replacement surgeries in which patients have to stay at least 3 days prior to surgery and a few days post-surgery. Medicare covers most of the cost and you will be responsible for part A deductibles. Hospital services may include:

• Medication while you’re in the hospital
• General monitoring
• Inpatients services
• Meals

Part B Coverage

Outpatient knee replacement surgery in which patients are discharged after the surgery is covered under Medicare part B. Part B covers 80% of the cost and you are responsible for the remaining 20% and deductibles. Any prescriptions given to you by your healthcare provider will be covered under Part B.

Medicare Advantage Plan

Medicare Advantage plan covers everything that’s in the original Medicare. With this plan, you’ll have to pay lower deductibles and a little out-of-the-pocket cost. If you have a Medigap plan, you might have zero out-of-the-pocket cost for total knee replacement surgery.

Apart from surgery, Medicare also covers alternative treatments to knee replacement surgeries which may include therapy and durable medical equipment such as orthopedic knee braces.

What Are The Criteria To Get Knee Replacement Surgery?

In order to get Medicare coverage for knee replacement, you must be old or have a medical condition that requires surgical treatment. There is no age limit, however, most people who undergo knee replacement surgeries are between 50 to 80 years old.

Should You Use A Knee Brace Post Knee Replacement Surgery?

A knee replacement surgery is performed to replace worn-out knee parts to help you improve your mobility. Once you have undergone the surgery, your doctor might recommend you use a knee brace to keep your knee joint instill and avoid micro-movements that may affect your recovery.

Orthopedic Knee braces are used to help support, stabilize and rehabilitate the knee brace post-surgery They are available in different styles so it’s best to consult your doctor and ask him which style is right for you after the knee replacement surgery.

Does Medicare Pay For Knee Braces?

Yes. A qualified Medicare beneficiary can get a knee brace after knee replacement surgery. Medicare pays for Knee braces under part B which means 80% of the cost will be covered. However, one has to pay the remaining 20% if their yearly deductibles are paid.

Note: Medicare doesn’t cover all types of knee braces. It only covers durable medical equipment which is rigid or semi-rigid. Therefore, knee bandages, wraparounds, and straps will not be covered by your insurance plan. You can purchase these knee braces online or in retail stores.

How To Get Knee Braces Covered By Medicare?

In order to get knee braces covered by Medicare, your doctor must prescribe one saying you need it for recovery after a knee implant. Your doctor or surgeon will have to sign a prescription so you get knee braces covered by Medicare.

You can get knee braces covered by Medicare if you have enrolled in Medicare part B. It will cost you much less than the retail price.

Note: Finding the right type and style of knee brace that is suitable for your condition and pain level is important. Instead of wasting money on the wrong knee brace that isn’t helping your condition, it’s recommended to ask your doctor before purchasing one. 

Conclusion

If you or any of your loved ones need knee replacement surgery, Medicare will reduce the out-of-the-pocket cost significantly. The cost coverage will depend on the specific insurance plan you have.

If you have undergone knee replacement surgery, you might need a knee brace for a full recovery. Daphco is an accredited supplier of Medicare knee braces. We provide knee braces for meniscus tears, knee immobilizer braces, and more depending on your condition.

Contact us to see if you’re eligible for a Medicare knee brace.