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.

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

Steve 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 Henderson · Answer

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

Vachik Chakhbazian · Answer

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

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.

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.

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.