Does Medicare pay 100% of knee replacement surgery?

No. Under Original Medicare, Part A covers the hospital stay after you pay the $1,676 deductible per benefit period. Part B covers the surgeon's fee at 80% after your $283 annual deductible. Without a Medigap plan, you're responsible for the remaining 20% coinsurance on Part B services, which can add up to thousands of dollars on a major surgery.

Will Medicare pay for knee replacement after age 70?

Yes. Medicare has no age limit on knee replacement coverage. The only requirement is that your doctor documents the procedure as medically necessary. Whether you're 66 or 86, the same coverage rules apply.

What is the average out-of-pocket cost for knee replacement with Medicare?

Costs vary by location, facility, and your coverage type. With Original Medicare alone, you could owe the Part A deductible ($1,676), 20% of the surgeon and anesthesia fees under Part B, and significant skilled nursing costs if rehab extends past 20 days. A Medigap Plan G holder typically pays only the $283 Part B deductible for the entire episode of care.

Does Medicare cover physical therapy at home after knee replacement?

If you qualify for Medicare home health services, Part A covers in-home physical therapy at no cost to you when ordered by your doctor. Outpatient PT at a clinic falls under Part B, where you'll pay 20% coinsurance per session after meeting the $283 deductible. Each session can run around $150 before Medicare adjustments, so those costs add up fast without supplemental coverage.

Medicare Broker for Knee Replacement Patients: Plan the Coverage Before You Plan the Surgery

A Medicare broker for knee replacement patients does one thing your surgeon's office won't: review your actual coverage before you're wheeled into the OR. I'm Anthony Orner, a licensed broker who helps people understand exactly what they'll owe for the hospital stay, the rehab, and the weeks of physical therapy that follow.

The wrong plan can cost you thousands in surprise bills. The right plan can reduce your out-of-pocket to almost nothing.

Call for Free Advice — 855-559-1700

What Original Medicare covers for total knee replacement

Medicare only covers knee replacement when your doctor documents it as medically necessary. Once approved, here's how the costs break down:

Part A covers the hospital stay after you pay the $1,676 deductible per benefit period
Part B covers the surgeon, anesthesiologist, and outpatient services at 80% after your $283 annual deductible
That remaining 20% on a $30,000+ surgery is real money

Skilled nursing and rehab: where the real costs add up

Many knee replacement patients need skilled nursing facility (SNF) care after discharge. Days 1-20 are covered at $0 under Part A. Days 21-100 cost you $209.50 per day in 2026 coinsurance.

That's up to $16,760 if you need the full 100 days. People don't expect this bill. A Medigap plan covers every dollar of it.

Outpatient physical therapy costs most people miss

Your surgeon will likely prescribe 8-10 weeks of PT, twice a week. Each session runs about $150 before Medicare adjustments. Under Part B, you pay 20% coinsurance per visit.

Over two months, that's $500+ out of pocket with Original Medicare alone. With Medigap Plan G, you pay $0 after your annual deductible.

Medigap vs. Advantage for major orthopedic surgery

Medicare Advantage plans cap your yearly out-of-pocket, which sounds great. But many Advantage plans require prior authorization, limit which surgeons you can see, and charge copays at every stage: hospital, SNF, PT visits.

Medigap Plan G paired with Original Medicare gives you the widest surgeon choice and the most predictable costs. For a planned surgery this significant, predictability matters.

If you need both knees done

Surgeons typically schedule each knee months apart. That means two hospital stays, two rounds of rehab, and potentially two Part A deductibles if they fall in separate benefit periods.

Getting the right supplemental plan before the first surgery protects you for both. Timing your enrollment matters as much as timing the procedure.

Schedule a free knee replacement coverage review

I'll pull up your current coverage, walk through the hospital, rehab, and PT costs specific to your situation, and show you exactly what you'll owe under each plan option. No cost, no obligation.

Call before your pre-op appointment. That's when this conversation helps most.

Talk to Anthony about your knee replacement coverage

855-559-1700

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