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?

Question

Dutch VanHoesen · Accepted Answer

Original Medicare: Medicare premium $185/mo, $257 deductible + (20% of $20,000 to $40,000 + post care costs) 
$5-10K no max out of pocket.

Medigap Plan G: $200-225/mo+
Medicare premium $185/mo, $257 deductible is your max out of pocket for the year

Medicare Advantage: Medicare premium $185/mo (may be reduced by up to $174,70/mo) specialist copay $10-$45+ outpatient hospital copay $100-$300 + post op rehab $20-$40/visit maximum out of pocket could be less than $500. Max out of pocket $1000-$6700.

Steve and Sue Brauer · Answer

Again, if a physician deems the procedure medically necessary, Medicare will cover robotic knee surgery. You may still be responsible for some out of pocket costs depending on your coverage.

Gary Church · Answer

To answer this question: If it is medically necessary, Medicare will cover the surgery, but they may only cover the standard knee replacement. I would advise reaching out to Medicare for clarification.

Answered by Gary Church on June 13, 2025

Broker Licensed in Ca, AZ, NV & TX

Answered by Gary Church Medicare Insurance Agent

Jennifer McDonnell · Answer

Most medical treatments that are considered 'experimental' are not covered by Medicare.
Check with your insurance prior to see if this will be covered.  If not, the expense will most likely be 100% your responsibility.  If you are a veteran, check with the VA to see if it is covered.

Sandra Teel · Answer

The answer to this question will depend upon the following.
1)  Whether Medicare approves of the robotic knee replacement surgery. If Medicare does NOT approve the surgery, they will not pay for it.  
2) If Medicare approves the surgery, then the type of insurance you have along with Medicare will determine the price you will pay for the surgery.

Ali Crouch · Answer

Medicare has a code for each procedure. Depending on which side of Medicare you choose—Original, with a supplement, or a Medicare Advantage plan—the amount you owe could look a little different. I would be more than happy to speak with anyone looking for this information and wanting to know what to expect. However, I cannot provide a definite answer without knowing your plan.

Answered by Ali Crouch on April 10, 2025

Broker Licensed in NE, AZ, CO & 9 other states

Answered by Ali Crouch Medicare Insurance Agent

Michael Ferraro · Answer

Medicare looks at is procedure covered. It doesn’t look at the technology that is used to do the procedure. As long as your dr says it is medically necessary and the drs office accepts Medicare assignment. There should be no issue

Answered by Michael Ferraro on July 30, 2025

Agent Licensed in NY

Answered by Michael Ferraro Medicare Insurance Agent

Steven Bleicher · Answer

You must ask your surgeon if this recommended procedure is covered by Medicare? If he pleads ignorance, he may not be trustworthy in this regard. When R&D (research & development) was happening (literally for years!), the suspicion had to be that there would be a process to get this experimental idea to be approved by both CMS & the CDC. If it has, great! If not, you’re paying for it.

Answered by Steven Bleicher on June 8, 2025

Broker Licensed in AZ

Answered by Steven Bleicher Medicare Insurance Agent

Diana Garner · Answer

Robotic knee replacement surgery would be covered if medically necessary and performed at a Medicare-approved facility by a Medicare-approved physician. 

Medicare Part A covers inpatient surgeries, while Part B covers outpatient procedures, including those performed in a hospital setting. 

You may need to pay a deductible and coinsurance, depending on your plan and the type of procedure.

Carolyn Duncan · Answer

We need to consult Medicare.gov and see how they would or would not cover the robotic knee replacement surgery. I can explain how various policies will work based on the approval or denial of the service. Helping you through this process would be best practice by any agent.

Answered by Carolyn Duncan on July 16, 2025

Agent Licensed in FL

Answered by Carolyn Duncan Medicare Insurance Agent

Christopher Orr · Answer

If your Medicare approves the procedure, it will be covered on an outpatient basis. You will be responsible for a $257 deductible and 20% of the cost. If you have a supplemental plan, it will cover the 20%. If you opt for a Medicare Advantage plan, it will cover all costs, subject to your outpatient copay, which typically ranges from $100 to $300 for most Tennessee plans.

Answered by Christopher Orr on June 2, 2025

Broker Licensed in TN, KY, NC & VA

Answered by Christopher Orr Medicare Insurance Agent

Fred Manas · Answer

Yes, Medicare generally covers robotic knee replacement surgery if it's deemed medically necessary and performed at a Medicare-approved facility. The procedure is covered under Medicare Part A for inpatient procedures and Part B for outpatient procedures. However, it's crucial to ensure the surgeon is a participating Medicare provider, even if operating remotely, according to Far North Surgery. 
Elaboration:
Medical Necessity:
Medicare coverage is contingent on your doctor determining that the robotic knee replacement surgery is medically necessary for your specific condition. 
Medicare-Approved Facility:
The surgery must be performed at a facility that is certified by Medicare. 
Participating Provider:
The surgeon performing the robotic knee replacement, even if operating remotely, needs to be a participating Medicare provider. 
Part A and Part B Coverage:
If the surgery is inpatient, it's covered under Medicare Part A. If it's an outpatient procedure, it's covered under Part B. 
Out-of-Pocket Costs:
While Medicare will cover a portion of the costs, you'll still have out-of-pocket expenses like the Part B deductible and coinsurance. 
Medigap Plans:
If you have a Medigap plan, it may help with the out-of-pocket costs like coinsurance and the Part B deductible, according to Robotic Orthopaedic Institute. 
Robotic Surgery Specifics:
The robotic knee replacement surgery is not inherently a separate coverage category. It's a surgical technique that, if medically necessary, is covered under the same Medicare rules as traditional knee replacement surgery.

Vachik Chakhbazian · Answer

Medicare covers knee replacement surgery, including robotic-assisted procedures, if your doctor determines it's medically necessary.

Gary Henderson · Answer

Yes, Medicare generally covers robotic knee replacement if it's deemed medically necessary and performed at a Medicare-approved facility

Andrew Kramer · Answer

Medicare covers robotic knee replacement. It would be the same co-insurance or co-pays as regular knee replacement surgery.

Suzanne Lamperti · Answer

Unfortunately it looks like Meducare does not cover that procedure. I suggest if you have a Meducare Supplement,  see if it will cover the procedure.

Sam Silva · Answer

Original Medicare (Part A and Part B) covers medically necessary knee replacement surgery, including the hospital stay (Part A) and outpatient services (Part B).

Robotic-assisted surgery is generally considered a type of minimally invasive surgery, which may offer benefits like smaller incisions and faster recovery, but the coverage would be the same as traditional knee replacement if it’s medically necessary for your condition.

Charles Borg · Answer

If it’s considered absolutely necessary, it might be covered. There would have to be a good reason why a regular knee replacement surgery wouldn’t work.

Ross Landon · Answer

That might be an overnight procedure & with most advantage plans surgery in a hospital would mean a co-pay per night of about $350 to maybe $500, depending upon your plan.   So if you have to stay a couple of days in the hospital, it’s still probably gonna be less than about $1000!  

If it is just same day surgery, it will be about that much co-pay for the single procedure itself. So still the cost is pretty reasonable for surgery. $350- $500.

Glenda Martin · Answer

Robotic knee replacement surgery is a type of advanced surgical procedure that uses robotic technology to assist surgeons during the operation. Medicare coverage for this procedure can vary depending on several factors.

*Medicare Coverage:*
Medicare typically covers knee replacement surgeries, including robotic-assisted procedures, when deemed medically necessary. However, coverage specifics may differ based on the type of Medicare plan you have (Original Medicare, Medicare Advantage, etc.) and the particular procedure.

*Key Considerations:*

- *Medicare Part A*: Covers hospital stays, which would include the surgical procedure.
- *Medicare Part B*: Covers doctor services, outpatient care, and some preventive services.
- *Coinsurance and Deductibles*: You may still be responsible for out-of-pocket costs, such as coinsurance and deductibles.

*To Confirm Coverage:*

- *Contact Medicare Directly*: Reach out to Medicare to determine the specifics of your coverage.
- *Consult with Your Surgeon*: Discuss the procedure with your surgeon to understand the medical necessity and potential benefits.
- *Check with Your Medicare Plan*: If you have a Medicare Advantage plan, review your plan's coverage details.

Or contact me directly and I will be happy to assist you with your insurance coverage 

It's essential to verify coverage and costs with Medicare and your healthcare provider to ensure a smooth process.