Medicare Broker for Hip Replacement Patients — Minimize Out-of-Pocket Surgery Costs

What Medicare pays for hip replacement surgery and rehab

Medicare covers medically necessary hip replacement. Part A handles the hospital stay. Part B covers the surgeon, anesthesiologist, physical therapy, and durable medical equipment like a walker.

In 2026, you'll pay the $1,676 Part A deductible per benefit period for inpatient stays. On the Part B side, you owe 20% of approved charges after a $283 annual deductible. That 20% on a major surgery adds up fast.

How Medigap plans eliminate your Part A and Part B gaps

A Medigap (Medicare Supplement) plan pays the costs Original Medicare doesn't. For hip replacement patients, the key benefits:

• Plan G covers the full Part A deductible ($1,676) and all Part B coinsurance (that 20%)
• Plan N covers the same deductible with slightly lower premiums, though you'll pay small copays at some visits
• No prior authorization, no network restrictions, no referral requirements

With Medigap, you pick your surgeon. Any doctor who accepts Medicare accepts your plan. That matters when you want a specific orthopedic specialist.

Medicare Advantage prior authorization for joint replacement

Medicare Advantage plans often require prior authorization before hip surgery. That means your insurer must approve the procedure before it happens. Denials and delays are real.

Some Advantage plans offer low out-of-pocket maximums that cap your total exposure. Others have narrow networks that limit your surgeon choices. I'll pull the actual cost-sharing details for plans in your area so you can see what you'd really pay.

Recovery costs most people don't plan for

Hip replacement today is often outpatient. You go home the same day. That changes the insurance math. Outpatient surgery runs through Part B, not Part A, so your cost-sharing looks different.

• Physical therapy visits (Part B: 20% coinsurance per session)
• Skilled nursing facility rehab: $0/day for days 1-20, then $209.50/day for days 21-100 in 2026
• Walker, raised toilet seat, and other durable medical equipment (Part B covers 80%)

People living alone or in multi-story homes face extra challenges during recovery. The right plan won't solve every logistics problem, but it removes the financial stress so you can focus on healing.

Timing your plan switch around surgery

If you're approaching 65 and know a hip replacement is coming, your Medigap Open Enrollment Period is the window. During the 6 months starting the month you turn 65 and are enrolled in Part B, carriers must accept you regardless of your hip condition. No medical underwriting.

Miss that window and a carrier can ask health questions. A pending joint replacement could mean higher rates or denial. Plan ahead. I help people lock in coverage months before their surgery date.

Compare plans before your hip surgery — free consultation

I compare Medigap and Advantage plans side by side, specific to your surgery timeline, your doctors, and your zip code. No cost to you. Carriers pay me, not you.

One call before surgery can save thousands after it. I'll show you the numbers so you can decide with confidence.

Related resources

• Medigap Plan G vs. Plan N: Which saves more for surgery?
• Medicare Advantage vs. Medigap: How to choose
• Medigap Open Enrollment: Why timing matters
• Medicare skilled nursing facility coverage explained