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

Question

Daniel Brechin · Accepted Answer

Yes, most on a same day surgery.   It is covered by supplement and Medicare Advantage plans.   Recovery is also covered for rehab a joint or procedurer.

Norman Smith · Answer

If I hide procedures are deemed “Medically Necessary “, then of course!
And if you have a supplemental or Medigap plan that will help with the difference, maybe cover it all depending on your plan.

Ann Sanfelippo · Answer

Yes, Medicare does cover hip, knee, and shoulder replacement surgeries when they are medically necessary. Under Original Medicare Part A, inpatient hospital stays for joint replacement are covered, and Part B covers the surgeon’s fees, outpatient procedures, and follow-up care. You are responsible for deductibles and coinsurance unless you have a Medigap plan or Medicare Advantage plan to help cover those costs. If you’re in a Medicare Advantage plan, coverage must be at least as good as Original Medicare, but prior authorization and network rules may apply.

Answered by Ann Sanfelippo on February 13, 2026

Broker Licensed in FL, AL, AZ & 14 other states

Answered by Ann Sanfelippo Medicare Insurance Agent

John Becker · Answer

Yes, Medicare covers hip, knee, and shoulder replacement surgeries, but only if they are deemed medically necessary by your doctor, covering common procedures like these joint replacements, plus related therapy (PT) and equipment, with costs depending on if you're in Original Medicare (Parts A & B) or a Medicare Advantage (Part C) plan, and whether it's inpatient (Part A) or outpatient (Part B).

Answered by John Becker on December 22, 2025

Agent Licensed in WI & MN

Answered by John Becker Medicare Insurance Agent

Mitchell Jerome · Answer

If you only have original Medicare A B then you'll pay deductibles and coinsurance. If you're in the hospital over 24 hours then you'll pay the Part A deductible $1736 (2026 rate) and then 20% for the doctor treatment. But if you have a Medigap plan it will cover those gaps. If plan G you'd pay only the Part B deductible $283 (2026) then everything else is covered. If you have an Advantage plan you'd have copays or coinsurance for outpatient surgery.

Answered by Mitchell Jerome on December 8, 2025

Broker Licensed in TX

Answered by Mitchell Jerome Medicare Insurance Agent

Kevin Dover · Answer

Yes, Medicare pays for all of the above. Medicare beneficiary with a Medigap plan G typically pays just the Part B annual deductible ($288). After Medicare pays 80%, the Plan G pays the balance. Medicare Advantage plan range from $200-$700 for the surgery.

Answered by Kevin Dover on December 4, 2025

Broker Licensed in FL, AL, AR & 16 other states

Answered by Kevin Dover Medicare Insurance Agent

Barry Baker · Answer

Medicare will pay up to 80% for all those surgeries if they are "medically necessary".
Call 800-medicare with your Medicare number and information to verify coverage.

Ted Wallus · Answer

This is where terminology can get mixed up, and plan specifics are important. Some folks ask, does "Medicare" pay... but they could mean, Original Medicare, A+B, Medicare Advantage Plans | Part C", or a Medicare Supplement (Medigap) Plan. 

That's why it's so important to speak with a reputable independent broker, but I'll answer as best as possible without that further clarification. 

If as an outpatient surgery, which most hip, knee, and shoulder replacements fall under, Medicare Part B would pay 80% of the cost. The other 20% would be on the beneficiary. That would be a sizeable bill, hence why so important to get additional coverage.

If as an outpatient surgery, under a Part C or Medicare Advantage plan, if in-network, you would likely have a flat co-pay. In the states where I write plans, the co-pay is about $300 per surgery. Not a bad deal for a $0 dollar premium Medicare Advantage plan.

If as an outpatient surgery, with Original Medicare Part A + B, plus a Medicare Supplement, depending on how comprehesive the Supplement is (F, G, N, etc.) you will likely have no co-pay. Medicare Part B will cover 80%, and your Supplement will cover the 20% balance.

John Burke · Answer

If you are admitted to the hospital. There will be a copayment based on the number of days( $250-450 per day) and the Medicare Advantage (MAPD) plan you have. On Original Medicare, your deductible is $1,736. 



For outpatient surgery,$300-500, depending on which MAPD plan you have. On  Original Medicare, you will pay 20% coinsurance of the Medicare-approved amount for outpatient surgery.

Rick Boyd · Answer

Medicare will pay for medically necessary services. If a joint replacement is medically necessary for you, then Medicare will cover it.

Valentina Gatewood · Answer

Yes, Medicare will cover joint replacements. The coverage amount depends on the plan that is chosen.

Sandy Nelson-Tittsworth, CMIP · Answer

Medicare covers hip, knee, and shoulder replacement surgeries if they are deemed medically necessary by a doctor. Coverage includes the procedure (inpatient or outpatient), the device, and related rehabilitation. Costs typically include a deductible, 20% coinsurance (Part B), and potential, though, with Medicare supplements reducing out-of-pocket expenses. Medicare Advantage Plans will be copays based on Hospital Stays or Ambulatory Surgical Center for operation. Then Physical Therapy for rehabilitation.

Answered by Sandy Nelson-Tittsworth, CMIP on February 17, 2026

Broker Licensed in FL, AL, AZ & 8 other states

Answered by Sandy Nelson-Tittsworth, CMIP Medicare Insurance Agent

Heidi Wotton · Answer

Yes. Medicare covers hip, knee, and shoulder replacement surgery when it is medically necessary.

Part A helps cover the hospital stay, and Part B helps cover the surgeon, outpatient services, and follow-up care. Your out-of-pocket costs will depend on whether you have Original Medicare only, a Medicare Supplement, or a Medicare Advantage plan.

Rukshini Sandrasegaran · Answer

This answer is provided in a video format. Watch the agent's video response here: https://medicareagentshub.com/questions/does-medicare-pay-for-hip-knee-or-shoulder-replacement-surgery#rukshini-sandrasegaran

Andrew Kramer · Answer

Yes of course! But it must be deemed "medically necessary" in order to get the authorization for such a procedure. An orthopedic Dr would do that.

Meghan Blankenship · Answer

Yes — Medicare does cover hip, knee, and shoulder replacement surgeries when they are medically necessary. Coverage is split between Part A (inpatient hospital care) and Part B (outpatient services and doctor fees). Patients are responsible for deductibles and coinsurance.

Answered by Meghan Blankenship on December 3, 2025

Broker Licensed in FL, MD & OH

Answered by Meghan Blankenship Medicare Insurance Agent

Antonio Rodriguez · Answer

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.

Blaine Shipe · Answer

Yes and many other surgeries. If you are still unsure you can reach out to a licensed broker or agent to do the checking on your coverage

Julia Alves · Answer

Yes! Medicare covers hip, knee, and shoulder replacement surgery when it’s medically necessary and ordered by a doctor.

Part A covers the hospital stay IF the surgery is inpatient.

Part B covers the surgeon, outpatient surgery, physical therapy, and equipment like walkers.

Most joint replacements are now done outpatient, which means Part B usually applies. After meeting the Part B deductible, Medicare typically covers 80%, and the remaining 20% depends on whether you have a Medigap.

Medicare Advantage plans also cover joint replacement surgery, but may have different costs, networks, or authorization requirements.

Rachida Silva · Answer

Yes, Medicare generally covers hip, knee, and shoulder replacement surgery, but it must be considered medically necessary by your doctor.

Chris Lewis · Answer

If recommended and approved by your PCP or specialist, Medicare Part A and Part B generally cover hip, knee or shoulder replacement. Prescriptions would fall under your Part D plan. Costs associated with co-pays, coinsurance and deductibles apply according to the planned coverage you have in place.

Answered by Chris Lewis on December 5, 2025

Broker Licensed in AL & GA

Answered by Chris Lewis Medicare Insurance Agent

Brittany Morris · Answer

Yes in and outpatient surgeries are covered by Medicare. Check your summary of benefits for specific plan information or contact Medicare. You can also download Medicare’s What’s Covered app and learn all about original Medicare coverage

Answered by Brittany Morris on December 6, 2025

Agent Licensed in LA

Answered by Brittany Morris Medicare Insurance Agent

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

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

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