Medicare Coverage for Common Surgeries: Hip Replacements, Cataracts, and More

Undergoing surgery can be stressful… Not only because of the procedure itself, but also because of worries about cost and coverage. For many older adults and Medicare beneficiaries, common surgeries like hip replacement or cataract removal are often part of life. Understanding how Medicare covers these procedures can help you plan ahead, avoid surprise bills, and focus on recovery with peace of mind.

This article walks through how Medicare handles coverage for some of the most common surgeries, what you may owe out of pocket, and what you should check before scheduling surgery.

How Medicare Covers Surgery

Medicare helps cover many medically necessary surgeries and related care under different parts of the program.

• Part A (Hospital Insurance) covers inpatient hospital stays (including room, meals, nursing care, and drugs) when you need to be admitted for surgery.

• Part B (Medical Insurance) covers outpatient surgeries, doctor services, and related care like follow-up visits, physical therapy, and needed medical equipment (for example, a walker after joint replacement).

• If you have a private Medicare Advantage (MA) plan, that plan must offer at least the same coverage as Original Medicare (Parts A and B). Depending on your MA plan, out-of-pocket costs and facility requirements may differ.

Because the setting (inpatient vs. outpatient) and the details of the procedure (what exactly is done, what after‑care is required) affect coverage, it is always important to check with your doctor and hospital in advance.

Sarah Murphy

Herd Health Insurance • Lake Ann, MI

I'm interested in a robotic knee replacement surgery that my surgeon recommends for my specific anatomy. How does Medicare coverage work for this advanced procedure?

In general, Medicare takes a look at robotic knee replacements like it does traditional knee replacements. However, like any medical procedure, it must be deemed as medically necessary. Medicare Part A covers the inpatient stay, while Part B covers outpatient services and doctor fees. If you have a Medicare supplemental plan, then that might help with your deductibles, coinsurance, including your out-of-pocket costs.

Confirm the details of your surgery with your surgeon's office; this will help with both Medicare Advantage and traditional Medicare with a supplement.

View all 48 answers »

Coverage for Specific Common Surgeries

Here’s how Medicare typically handles several surgeries that many beneficiaries face:

Hip and Knee (Major Joint) Replacements

• When a hip or knee replacement (or similar major joint replacement) is medically necessary (for example, because of advanced arthritis, joint damage, or failure of non-surgical treatments), Medicare helps with the cost.

• If you are admitted to a Medicare‑approved hospital for the surgery, Part A will cover the hospital stay: semi‑private room, meals, general nursing care, inpatient drugs, and other hospital services.

• If the surgery happens at an outpatient surgical facility, Part B applies, covering the surgery itself, the surgeon’s and doctor’s fees, and medically necessary follow-up care (like physical therapy and rehab services, doctor visits, and durable medical equipment such as a walker).

• For after‑surgery rehabilitation, if you need care at a skilled nursing facility (after a qualifying inpatient stay), Part A may cover a portion.

• If you have a supplemental coverage plan (sometimes called a “Medigap” policy), it may help cover the cost of coinsurance, deductibles, or other out-of-pocket expenses. With Plan G, for example, you’d owe only the Part B deductible, and the plan picks up the Part A deductible and the 20% Part B coinsurance.

Because each patient’s situation is different, from health condition to type of facility, it is wise to talk with your doctor and the hospital billing department before scheduling surgery.

Antonio Rodriguez

NW Senior Benefits • Eugene, OR

Does Medicare pay for hip, knee, or shoulder replacement surgery?

Yes—Medicare does cover hip, knee, and shoulder replacement surgery when it’s medically necessary.

• The surgery itself is covered under Part A (if you’re admitted to the hospital) and Part B (surgeon fees, outpatient procedures, therapy, etc.).

• Medicare also covers post-surgery rehab, physical therapy, and necessary medical equipment.

• Your exact cost depends on whether it’s inpatient or outpatient and what type of Medicare plan you have.

View all 26 answers »

Cataract Surgery

• Medicare covers medically necessary cataract surgery under Part B for most beneficiaries.

• This coverage includes removal of the cloudy natural lens and implantation of a standard intraocular lens (IOL).

• If you choose a premium lens, like a toric lens to correct astigmatism or a multifocal lens to cut down on reading glasses, Medicare still pays its share of the standard surgery. You pay the difference for the upgraded lens and the extra testing and services that go with it. Laser-assisted cataract surgery is usually billed the same way when it’s used to place one of those lenses, so get the price in writing before your surgery date.

• After you meet the Part B deductible, typically you pay 20% of the Medicare‑approved amount for both the surgical facility and the doctor performing the procedure.

• If you need corrective eyeglasses or contact lenses after surgery (because of the lens implant), Medicare will cover one pair of eyeglasses with standard frames or one set of contacts after each cataract surgery, as long as you get them from a Medicare‑approved supplier.

• Note that Medicare does not usually cover routine vision care, so coverage applies specifically because of the cataract surgery, not routine eye exams or cosmetic vision procedures.

If you have a Medicare Advantage plan, coverage for cataract surgery is still required. However, copays or facility requirements may vary, so be sure to ask your plan provider.

Stacey Portugal

Main Line Benefits • Des Plaines, IL

Is Medicare's coverage for cataract surgery enough, or do seniors still face high out-of-pocket costs?

Yes, there are often out-of-pocket costs for cataract surgery, but it depends on the coverage. If you have Original Medicare, your Part B will cover 80% of the cost after the Part B deductible has been met. If you have a Medicare Supplement in addition to your Part B, the cost can vary depending on the plan that you chose. Medicare will also cover one pair of standard eyeglasses or contact lenses after cataract surgery with an intraocular lens.

If you have a Medicare Advantage plan, the plan will cover the surgery, but copays and coinsurance vary from plan to plan, so it's best to call customer service or your agent to determine the cost.

As for the optional upgrades, Medicare generally does not fully cover these, so please check with your doctor.

View all 55 answers »

Other Common Procedures (Tumor Removal, Hernia Repair, Cardiac & Injury‑Related Surgeries)

Medicare also covers many other medically necessary surgeries needed to treat illnesses, injuries, or disease (for example, hernia repair, tumor removal, surgeries after fractures or injuries, some cardiac procedures, etc.).

• Hernia repair is usually done as same-day outpatient surgery, so it falls under Part B. You’d pay the Part B deductible and 20% of the Medicare-approved amount for the facility and the surgeon.

• Heart procedures like bypass surgery generally require a hospital admission, so Part A covers the hospital stay and Part B covers the surgeon. Stents and pacemakers can be done either way, depending on your condition and your doctor’s orders.

• Tumor removal is covered when your doctor says it’s medically necessary, whether the growth is cancerous or benign. If it’s cancer, follow-up treatment like chemo or radiation falls under Medicare’s cancer treatment coverage.

• Injury-related surgery, like repairing a broken hip after a fall, is often an emergency admission. That means Part A for the hospital stay and possibly skilled nursing rehab afterward.

Priscilla Ramos

Ellis & Smith Group LLC • Sheffield Lake, OH

I'm interested in a robotic knee replacement surgery that my surgeon recommends for my specific anatomy. How does Medicare coverage work for this advanced procedure?

Medicare covers robotic-assisted knee replacement the same way it covers a traditional knee replacement if it's medically necessary. Medicare pays for the surgery itself—not the robotic technology. If your surgeon recommends robotic assistance because it's best for your specific anatomy, coverage is generally based on medical necessity, not the surgical technique.

Original Medicare (Part A & Part B): Covers the hospital stay, surgeon, anesthesia, and rehabilitation after you meet applicable deductibles and coinsurance.

Medicare Advantage (Part C): Also covers medically necessary knee replacement, but you'll need to use the plan's network and may need prior authorization. Your out-of-pocket costs depend on your plan.

It's always a good idea to confirm that both the surgeon and hospital are in-network (for Medicare Advantage) and that any required prior authorization has been approved before surgery.

View all 48 answers »

After the surgery, if you require medical equipment (walkers, wheelchairs, other durable medical equipment) or outpatient therapy, Medicare may cover these - typically under Part B, subject to deductible and coinsurance.

However, Medicare does not cover every kind of procedure. For example, purely cosmetic surgeries (done for appearance, not for medical necessity) are generally not covered.

Things to Keep in Mind

• Medicare will only help with surgeries deemed “medically necessary”. If a procedure is elective (or purely cosmetic) Medicare typically will not cover it.

• Whether surgery is covered under Part A (inpatient) or Part B (outpatient) affects what you pay. Hospital stays under Part A involve a deductible, and Part B outpatient services generally include a deductible plus coinsurance (often 20% of the Medicare-approved amount).

  In 2026, the Part A deductible is $1,736 per benefit period and the Part B deductible is $283 a year. Say you have an outpatient hernia repair with a Medicare-approved amount of $3,000 and you haven’t paid anything toward your Part B deductible yet. You’d pay the $283 deductible plus 20% of the remaining $2,717 ($543), or about $826 total. An inpatient hip replacement works differently. The $1,736 Part A deductible covers your first 60 days in the hospital, and you’d still owe 20% of the surgeon’s and anesthesiologist’s fees under Part B.

• If you have other coverage like a Medigap supplement, or Medicaid, or employer/spouse insurance, these could help reduce what you pay out of pocket.

• Choosing a Medicare-approved hospital or surgeon is important. Also verify that the surgical center or equipment supplier accepts Medicare assignment or is Medicare‑enrolled before your procedure.

• If you have a Medicare Advantage (MA) plan, coverage is at least the same as Original Medicare, but details like out-of-pocket costs, network providers, and plan rules may differ. Always confirm coverage with your plan before scheduling surgery. Medicare Advantage plans often require prior authorization for surgeries like joint replacements, so make sure that step is handled before your procedure date. If your plan is an HMO, an out-of-network surgeon or hospital usually isn’t covered at all unless it’s an emergency. PPOs do pay for out-of-network care, but you’ll pay more.

Why It Helps to Work With a Medicare Broker or Agent

If you find Medicare benefits and surgical coverage confusing, you are not alone. Many beneficiaries benefit from speaking with a knowledgeable broker or agent who can help explain plan differences, check that your providers are Medicare‑approved, and help you understand what your out-of-pocket costs might be.

That is where a resource such as Medicare Agents Hub can help by connecting you to Medicare brokers or agents who specialize in helping people navigate Medicare coverage, especially when surgery or other major medical needs are involved.

A good agent can help you choose a plan that works for your health needs, and help you anticipate costs for surgeries, aftercare, physical therapy, and durable medical equipment.

Conclusion

For many older adults, surgeries like hip replacements and cataract removal are common and often medically necessary. The good news is that Medicare, whether Original Medicare (Parts A and B) or a Medicare Advantage plan, generally covers these procedures if they are deemed medically necessary.

While there may still be some out‑of‑pocket costs (deductibles, coinsurance, equipment, or supplies), knowing ahead of time how Medicare handles coverage can help you plan financially and medically. Working with a licensed Medicare broker or agent (for example through Medicare Agents Hub) can make the process smoother and help ensure you get the care you need.