Does Medicare cover shoulder replacement surgery?

Question

Daniel Neale · Accepted Answer

Yes. Medicare may cover shoulder replacement surgery when it is medically necessary, but how it’s covered depends on the type of Medicare coverage you have.

Medicare Part A helps cover inpatient hospital care if you are formally admitted to the hospital for the surgery. This can include your hospital stay, meals, nursing care, and some rehabilitation services after surgery.

Medicare Part B helps cover outpatient medical services, including doctor visits, imaging, the surgeon’s fees, outpatient surgery centers, durable medical equipment like slings or walkers, and physical therapy. Part B typically covers 80% of approved costs after your deductible, leaving you responsible for the remaining 20% unless you have supplemental coverage.

Medicare Part C (Medicare Advantage) combines Part A and Part B coverage through a private insurance company. These plans must cover everything Original Medicare covers, but costs, prior authorization requirements, hospital networks, copays, and rehabilitation coverage can vary by plan, so it’s important to review your specific benefits carefully.

Jesse Leal · Answer

Yes. In most cases, Medicare covers medically necessary shoulder replacement surgery.

If you’re enrolled in Original Medicare:
• Medicare Part A helps cover your inpatient hospital stay if you’re admitted.
• Medicare Part B helps cover the surgeon, anesthesia, outpatient services, physical therapy, and follow-up care.
• You’ll still be responsible for any deductibles, coinsurance, and copays unless you have supplemental coverage.

Michael Wallner · Answer

Medicare does cover shoulder replacement surgery that is considered medically necessary as per your doctor’s order. This is a standard surgical procedure similar to knee and hip replacement surgery, many times provided on an outpatient basis. Remember, Traditional Medicare only covers 80% of the cost for Outpatient Medical Services. 20% is due for the patient. If the procedure is done in an Inpatient setting, a deductible will be due… about $2,000 in 2026.

Answered by Michael Wallner on May 11, 2026

Agent Licensed in DE, MD & NY

Answered by Michael Wallner Medicare Insurance Agent

Anthony Mendez · Answer

Yes, Medicare does cover shoulder replacement surgery. With Original Medicare, patients average between $934 at an ambulatory surgical center to $1,677 at an outpatient hospital in out of pocket costs. A Medicare Supplement/Medigap or Medicare Advantage plan can reduce those out of pocket costs.

Answered by Anthony Mendez on June 22, 2026

Broker Licensed in AZ, CA, FL & IA, NE, NV & TX

Answered by Anthony Mendez Medicare Insurance Agent

Jon Cavanaugh · Answer

Yes, Medicare generally covers shoulder replacement surgery when your doctor determines it is medically necessary.
Your cost depends on whether the surgery is performed as an inpatient or outpatient procedure. With a Medicare Advantage plan, check the surgeon, hospital, prior authorization requirements, and expected copay before scheduling.

Ja&#039;el Michael · Answer

Yes, if your doctor feels it is necessary. Medicare Part A covers Hospital and Medicare part B covers Medical expenses like doctor visits. 

If you only have Medicare Part A and Part B, you will have out of pocket costs though. As you can see on the Medicare website here: https://www.medicare.gov/procedure-price-lookup/cost/23472/

If you have additional coverage like supplemental/ Medigap coverage or a Medicare Advantage Plan, it changes your costs. Please contact your member services for precise numbers.

Chris Oates · Answer

Medicare usually covers shoulder replacement surgery when it is considered medically necessary by your doctor. Coverage may include the hospital stay, surgeon fees, anesthesia, rehabilitation, and follow-up care. However, out-of-pocket costs can differ depending on whether you have Original Medicare, a Medicare Supplement, or a Medicare Advantage plan.

Answered by Chris Oates on May 7, 2026

Broker Licensed in MD, DC, DE & 8 other states

Answered by Chris Oates Medicare Insurance Agent

Jake Purvis · Answer

Yes, Medicare covers medically necessary shoulder replacement surgery. Medicare Part A helps cover the hospital portion, while Part B helps cover doctor visits, outpatient care, and follow up treatment. Your actual out of pocket costs will depend on the type of Medicare coverage you have.

Answered by Jake Purvis on May 11, 2026

Broker Licensed in FL, GA & TX

Answered by Jake Purvis Medicare Insurance Agent

Cathy Barnett · Answer

Yes, Medicare covers Shoulder replacement surgery. If you're in an MAPD plan, it must cover what Medicare covers. However, you'll need a doctor to write up an order stating you qualify for the replacement surgery.

Answered by Cathy Barnett on May 10, 2026

Broker Licensed in TX, AL, KY, NC & SC

Answered by Cathy Barnett Medicare Insurance Agent

Zachary Montgomery · Answer

Medicare covers medically necessary surgeries and procedures following the part b deductible and coinsurance costs. If a joint replacement is considered medically necessary, it is covered. In my experience in my practice, if pain or lack of functionality has gotten to the point a doctor recommends replacement, Medicare will cover.

Answered by Zachary Montgomery on May 20, 2026

Agent Licensed in GA, AL, IA, IL, SC & TN

Answered by Zachary Montgomery Medicare Insurance Agent

Chad Sickle, RN · Answer

Yes. Medicare covers shoulder replacement surgery. Any surgery that is necessary and Medicare approved is covered. Depending on the plan you are on will decide how much out of pocket you have to pay.

Answered by Chad Sickle, RN on June 16, 2026

Broker Licensed in NC & SC