---
title: "Medicare and joint replacement: What is covered by medical insurance"
description: Learn how Medicare covers joint replacement surgery, including Part A and Part B coverage, and Medicare Advantage plans.
---

[A Healthcare Blog ](https://www.actionbenefitsagency.com/blog)

# [Medicare and joint replacement: What is covered by medical insurance](https://www.actionbenefitsagency.com/blog/medicare-and-joint-replacement-what-you-need-to-know)

 Written by [Action Benefits](https://www.actionbenefitsagency.com/blog/author/action-benefits) | Aug 13, 2024 2:06:18 PM

Joint replacement surgery can be a life-changing procedure for many individuals. Understanding how Medicare covers this surgery can help you anticipate costs for other services.

#### Medicare Part A and Part B: Joint Replacement Coverage

**Medicare Part A** primarily covers hospital stays and inpatient care. If your joint replacement requires a hospital stay, Part A will likely cover:

- Hospital room and board
- Meals
- Nursing care
- Medications administered during your stay
- Surgical fees
- Use of the operating room

It's important to note there is a deductible for Part A, and after a certain number of days, you may be responsible for coinsurance.

**Medicare Part B** covers medically necessary doctor's services, outpatient care, and medical equipment. In the context of joint replacement, Part B typically covers:

- Surgeon's fees (if the surgery is performed on an outpatient basis)
- Anesthesiologist fees
- Physical therapy and rehabilitation
- Durable medical equipment (like walkers or wheelchairs)
- Outpatient diagnostic tests

Similar to Part A, Part B has deductibles and coinsurance that may apply.

#### Medicare Advantage Plans: A Different Approach

- Medicare Advantage plans are offered by private insurance companies and approved by Medicare. These plans often include the benefits of Part A and Part B. Prescription drug coverage through Part D is usually, but not always, included.

However, coverage for joint replacement can vary significantly between plans. It's essential to review the specific benefits of your Medicare Advantage plan to understand your coverage.

#### When is a Joint Replacement Considered Medically Necessary?

Medicare will only cover joint replacement surgery if it's deemed medically necessary. This means your doctor must determine the surgery is required to treat a medical condition and improve your quality of life. Factors indicating a medically necessary joint replacement include:

- Severe joint pain limiting daily activities
- Bone-on-bone arthritis
- Joint stiffness
- Loss of mobility
- Failed conservative treatments (like physical therapy or medications)

**If you have questions about Medicare coverage for joint replacement surgery or would like to explore your options, don't hesitate to get in touch with [Action Benefits Insurance Agency](https://www.actionbenefitsagency.com/contact-individual-medicare).** Our knowledgeable team can help you understand your coverage and find the right plan for your needs.

**Disclaimer:** This blog is intended for informational purposes only and does not constitute professional medical or financial advice. Please consult with a healthcare provider or financial advisor for personalized guidance.

[View full post](https://www.actionbenefitsagency.com/blog/medicare-and-joint-replacement-what-you-need-to-know)

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