Does Medicare Cover Knee & Hip Replacement? A California Guide

Published June 2026.

Yes — Medicare covers total knee and total hip replacement when the surgery is medically necessary, which in practice means documented arthritis that has stopped responding to non-surgical care. What you actually pay depends mostly on whether your operation is billed under Part A (inpatient) or Part B (outpatient), and on whether you carry supplemental coverage.

Most of the patients I operate on in Long Beach are on Medicare in one form or another — Original Medicare alone, Original Medicare with a Medigap supplement, or a Medicare Advantage plan. So this is not an abstract question in my clinic. It comes up nearly every week, usually phrased as: “Will Medicare actually pay for this, and what’s my share?”

I’m Dr. Leo Zalikha, a Stanford fellowship-trained joint replacement surgeon. The honest answer has two parts. The coverage part is simple: Medicare has covered medically necessary joint replacement for decades [2]. The cost part is where people get lost, because the answer changes depending on whether you’re classified as an inpatient or an outpatient — a distinction most patients never think about until the bill arrives. One more thing worth saying up front: Medicare’s rules and dollar amounts are federal. The deductibles in this guide are the same in Long Beach as they are in Sacramento or Miami. What California changes is the menu in front of you — which facilities, which plans, and which surgeons are in reach.

Does Medicare cover knee and hip replacement?

Medicare covers medically necessary inpatient and outpatient surgery, and its own rules have allowed total knee replacement to be performed as a hospital outpatient procedure since 2018 and total hip replacement since 2020 [2][6][7].

“Medically necessary” is the phrase doing all the work in that sentence. In practice, Medicare looks for what any careful surgeon should already have in the chart: advanced arthritis on imaging, pain and functional limits that genuinely interfere with your life, and a documented trial of non-surgical care — activity modification, medications, physical therapy, often injections. There is no age cutoff, no fixed waiting period, and no requirement that you reach some level of disability first.

What I tell my patients is what I’d tell a family member: we treat the patient, not the X-ray. I don’t recommend surgery because an image looks bad, and Medicare doesn’t pay because one does either. When surgery is genuinely indicated, the records reflect it and coverage follows. Where patients do hit friction, it’s almost never Original Medicare — it’s prior authorization with Medicare Advantage plans, which I’ll come back to below.

What does Part A pay vs. Part B?

In 2026, the Part A inpatient deductible is $1,736 per benefit period and the Part B annual deductible is $283, after which you pay 20% of the Medicare-approved amount for outpatient care [1][4].

The cleanest way I’ve found to explain this: it’s the same operation either way, but it travels through two different billing universes. If you’re formally admitted to the hospital, Part A (hospital insurance) pays. If your surgery happens in a hospital outpatient department or an ambulatory surgery center, Part B (medical insurance) pays. Here’s how they compare:

One detail that surprises people: for costly procedures Medicare classes as “comprehensive services” — and medicare.gov names total knee replacement specifically — the 20% coinsurance applies to the entire episode of care, including drugs, laboratory tests, and other services bundled into it [5]. That’s mostly good news. Fewer separate line items means fewer surprises.

Inpatient or outpatient — who decides?

Total knee replacement came off Medicare’s inpatient-only list in 2018 and total hip replacement in 2020, and Medicare now also pays for both in approved ambulatory surgery centers — knees since 2020, hips since 2021 [6][7][8].

Be careful reading those milestones: removal from the inpatient-only list means Medicare may pay for outpatient surgery, not that anyone is required to have it that way. Plenty of my patients are still best served by a night in the hospital, and that’s not a failure of anything — it’s good judgment.

So who decides? On paper, your surgeon. In practice, your physiology: heart and lung health, blood-sugar control, anesthesia risk, and who’s at home with you for the first few nights. Same-day joint replacement is a genuinely good option for the right patient — I’ve written candidacy guides for outpatient knee replacement and outpatient hip replacement that go through this honestly — but it is a medical decision, not a billing preference. A patient who should stay the night, stays the night.

In my own practice, outpatient cases are done at the Surgery Center of Long Beach and inpatient cases at MemorialCare Long Beach Medical Center. Medicare’s rules are identical at both; what changes is which part of Medicare pays and what your share looks like.

What will I actually pay?

For a knee replacement done as an outpatient (CPT 27447), Medicare’s national averages are $14,275 total in a hospital outpatient department versus $10,552 in an ambulatory surgery center, with the patient’s share averaging $1,967 and $2,109 respectively [9].

Those four numbers deserve careful labeling, because they’re the most concrete figures in this article: they are national averages for the knee procedure code, published in Medicare’s own Procedure Price Lookup tool — not California quotes, and not my prices. Medicare publishes equivalent figures for the hip code in the same tool; I’ve kept to the knee numbers here because they’re the ones I verified for this article.

Notice the wrinkle in them, though: the surgery-center total is $3,723 lower overall, yet the patient’s average share there is slightly higher — $2,109 versus $1,967 [9]. That’s a quirk of how Medicare calculates copays, not a typo, and it’s a useful reminder that “the cheaper setting” and “cheaper for you” are not always the same thing.

If you’re admitted as an inpatient instead, the math simplifies: you owe the $1,736 Part A deductible for the benefit period, and your first 60 hospital days are then covered in full [1][3]. Joint replacement stays run nowhere near that long.

After surgery, Part B keeps working — and so does its cost-sharing. Follow-up visits and outpatient physical therapy carry the same 20% coinsurance after the deductible, and there is no annual cap on what Medicare pays for medically necessary outpatient therapy [11][12]. A Medigap supplement can absorb much of this; covering Part A and Part B cost-sharing is precisely what those policies exist to do.

If you want the fuller cost picture — list prices versus negotiated versus cash prices, commercial insurance, and the practical ways to lower what you pay — I’ve written detailed guides on knee replacement costs in California and hip replacement costs in California.

Does Medicare Advantage change things?

However you receive your Medicare, most people keep paying the standard Part B premium — $202.90 per month in 2026, with higher-income beneficiaries paying more [1].

Medicare Advantage plans are required to cover everything Original Medicare covers, including medically necessary joint replacement. What changes is the machinery around it: copay structures instead of the deductible-plus-20% formula, provider networks that may or may not include your surgeon or facility, and — in my experience, almost universally — prior authorization before surgery is approved. None of that makes Advantage plans bad; it makes them different, and the differences only show up if you ask.

I’m deliberately not listing which plans our office works with, because networks change every year and a blog post would quietly go stale. Do this instead. Call the number on your plan card and ask four questions: Is my surgeon in network? Which facilities am I approved to use? Is prior authorization required for joint replacement? What are my inpatient and outpatient copays? Then call our office at (562) 362-5024 and we’ll verify everything from our end before anything gets scheduled.

If you have Original Medicare plus a Medigap supplement, the picture is usually simpler: Medigap policies exist to pay some or all of the Part A and Part B cost-sharing described above. How much they pay varies by policy, so the same call-your-plan advice applies — there are just fewer moving parts.

What about the costs Medicare won’t cover?

If you’re considering PRP injections for knee arthritis before committing to surgery, plan on paying 100% of the cost yourself — Original Medicare covers PRP only for certain chronic non-healing diabetic wounds [10].

Patients are sometimes surprised by that, having assumed Medicare covered the injections a clinic offered them. It doesn’t: knee osteoarthritis falls outside every nationally covered indication for PRP [10]. That doesn’t make PRP worthless — the evidence is genuinely mixed, and I’ve laid it out separately on our PRP and biologic injections page — but it does make it an out-of-pocket decision, and you should know that before the first injection, not after.

Beyond that, the gaps that matter most to my joint replacement patients are mundane. Medicare generally does not pay for everyday help at home — cooking, bathing, driving — or for most home modifications such as grab bars and ramps, or for routine transportation to appointments. None of these are surgical costs, but they are real costs of recovery, and the families who plan for them have noticeably smoother first weeks. And your premiums — Part B plus any Medigap or Advantage premium — continue through your surgery year, which is worth counting if you’re budgeting tightly.

Frequently Asked Questions

Does Medicare cover knee and hip replacement surgery?

Yes. Medicare covers total knee and total hip replacement when the surgery is medically necessary. Inpatient surgery is covered under Part A, and outpatient surgery — in a hospital outpatient department or a Medicare-approved ambulatory surgery center — is covered under Part B [1][2]. There is no age cutoff and no automatic waiting period; what matters is documentation of advanced arthritis and an adequate trial of non-surgical care.

How much does a knee or hip replacement cost with Medicare?

For inpatient surgery, you pay the Part A deductible of $1,736 (2026), which applies per benefit period and then covers hospital days 1–60 in full [1][3]. For outpatient surgery, you pay the $283 Part B deductible plus 20% coinsurance; for a knee replacement, the national-average patient share is $1,967 in a hospital outpatient department and $2,109 in an ambulatory surgery center [9]. Medigap or Medicare Advantage coverage changes these amounts.

Do I have to stay overnight in the hospital for a joint replacement on Medicare?

Not necessarily. Medicare removed total knee replacement from its inpatient-only list in 2018 and total hip replacement in 2020, and it now also pays for both procedures in approved ambulatory surgery centers — knees since 2020, hips since 2021 [6][7][8]. Whether same-day surgery is appropriate for you is a medical decision based on your overall health and home support, not a billing rule.

Does Medicare Advantage cover knee and hip replacement?

Yes. Medicare Advantage plans must cover everything Original Medicare covers, but your out-of-pocket costs, provider network, and prior-authorization requirements depend on your specific plan. Call your plan to confirm your surgeon and facility are in network and ask whether prior authorization is required, then call our office at (562) 362-5024 so we can verify coverage from our end before scheduling.

Does Medicare cover PRP injections for knee arthritis?

No. The only PRP use Original Medicare covers nationally is the treatment of certain chronic non-healing diabetic wounds; PRP for knee osteoarthritis falls outside every covered indication, so patients pay the full cost out of pocket [10].

Does Medicare pay for physical therapy after knee or hip replacement?

Yes. After you meet the Part B deductible, you pay 20% of the Medicare-approved amount for outpatient physical therapy, and there is no annual limit on what Medicare pays for medically necessary outpatient therapy services in a calendar year [12].

Related Reading

• Pre-Op Checklist for Joint Replacement – how to prepare once surgery is scheduled
• Knee Replacement Recovery – timeline and expectations
• Hip Replacement Recovery & Rehab – what the first weeks look like
• Virtual Second Opinion – if you want my read on your imaging and records

If you’re in Long Beach, greater Los Angeles, or Orange County and Medicare questions are the thing standing between you and a decision, bring them to the consultation — the coverage conversation and the surgical conversation belong in the same room.

References

1. Centers for Medicare & Medicaid Services. 2026 Medicare Parts A & B Premiums and Deductibles. CMS.gov fact sheet, November 14, 2025. CMS.gov
2. Surgery. Medicare.gov, U.S. Centers for Medicare & Medicaid Services. Accessed June 11, 2026. Medicare.gov
3. Inpatient hospital care. Medicare.gov, U.S. Centers for Medicare & Medicaid Services. Accessed June 11, 2026. Medicare.gov
4. Outpatient hospital services. Medicare.gov, U.S. Centers for Medicare & Medicaid Services. Accessed June 11, 2026. Medicare.gov
5. Outpatient medical & surgical services & supplies. Medicare.gov, U.S. Centers for Medicare & Medicaid Services. Accessed June 11, 2026. Medicare.gov
6. Centers for Medicare & Medicaid Services. CMS Issues Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Final Rule (CMS-1678-FC). CMS.gov fact sheet, November 1, 2017. CMS.gov
7. Centers for Medicare & Medicaid Services. CY 2020 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Final Rule (CMS-1717-FC). CMS.gov fact sheet, November 1, 2019. CMS.gov
8. Centers for Medicare & Medicaid Services. CY 2021 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Final Rule (CMS-1736-FC). CMS.gov fact sheet, December 2, 2020. CMS.gov
9. Procedure Price Lookup: Total knee arthroplasty (CPT 27447), national average costs in hospital outpatient departments and ambulatory surgical centers. Medicare.gov, U.S. Centers for Medicare & Medicaid Services. Accessed June 11, 2026. Medicare.gov
10. Centers for Medicare & Medicaid Services. National Coverage Determination (NCD) 270.3: Blood-Derived Products for Chronic Non-Healing Wounds. CMS Medicare Coverage Database, last reviewed April 2021. CMS.gov
11. Medicare costs. Medicare.gov, U.S. Centers for Medicare & Medicaid Services. Accessed June 11, 2026. Medicare.gov
12. Physical therapy services. Medicare.gov, U.S. Centers for Medicare & Medicaid Services. Accessed June 11, 2026. Medicare.gov

Medical Disclaimer: This blog post is for educational purposes only and does not constitute medical or financial advice. Medicare figures cited are the published 2026 amounts and national averages at the time of writing; your actual costs depend on your coverage, plan, facility, and medical circumstances. Always verify benefits with Medicare or your plan, and consult Dr. Zalikha or another qualified physician for a personalized evaluation and treatment plan.