Hip Replacement Cost in California: What Insurance Covers

Your hip has reached the point where the conversation has turned to surgery. Maybe it’s bone-on-bone arthritis on the X-ray; maybe it’s the groin pain that now wakes you at night. Whatever brought you here, the next question I hear in clinic is almost always the same: “What is this actually going to cost me?”

The honest answer for California patients: the price depends on the facility, the surgical setting, and how you pay, far more than on the surgical approach or the implant. This guide walks through hip replacement costs with Medicare, with commercial insurance, and without insurance, using published figures rather than marketing estimates.

Quick Summary :
In California, what you pay for a hip replacement depends less on your region than on the specific facility, the surgical setting, and how you pay. Hospital list prices run far above negotiated and cash prices: a 2023 study of top US orthopedic hospitals found a median list price of $68,016 for a primary hip or knee replacement [5], while negotiated prices in one large California health system averaged $54,500 [4]. With Original Medicare, an inpatient stay involves the $1,736 Part A deductible (2026, per benefit period) [1]; outpatient surgery falls under Part B, where the $283 deductible and 20% coinsurance apply and the hospital outpatient copay for the procedure cannot exceed the inpatient deductible [1][2]. With commercial insurance, a 2022 claims analysis found a mean out-of-pocket cost of $2,884 for total hip replacement [8]. Medicare has paid for outpatient hip replacement since 2020 [6] and for surgery-center hip replacement since 2021 [7].

Without Insurance: Total Cost Ranges

If you’re paying without insurance, understand first that there is no single price for a hip replacement: the list (chargemaster) price, the negotiated insurance rate, and the cash price for the same operation are three different numbers, with large gaps between them. A 2023 study of listed chargemaster prices at top US orthopedic hospitals found a median of $68,016 for a primary hip or knee replacement, with a range of $39,927 to $195,264 [5]. Cash prices usually sit well below list prices, which is why the single most useful step is to ask each facility for its posted cash-pay price.

A complete self-pay quote should itemize:

• Facility fee (operating room, recovery, nursing care)
• Surgeon’s fee
• Anesthesia fee
• Implant cost, confirmed as included in the facility fee (implants are bundled into the facility charge, not a separate purchase)
• Pre-operative testing (X-rays, labs, EKG)
• Post-operative care (ask whether follow-up visits are included in the surgeon’s fee)

How much prices actually vary: Within a single large California health system, negotiated prices for the same joint replacement averaged $54,500 but ranged from about $20,000 to nearly $79,000 depending on the payer [4], so generic county-level estimates are not a reliable guide.

The practical tool is price transparency: since January 1, 2021, every hospital has been required to post its standard charges online, including the rates it negotiates with insurers and the discounted cash price it accepts, free of charge and in a consumer-friendly format [3]. Look up each facility you’re considering before you schedule.

With Medicare: 2026 Out-of-Pocket Costs

Medicare covers hip replacement when deemed medically necessary, and the setting rules have moved in patients’ favor: total hip replacement came off the inpatient-only list in 2020, allowing hospital outpatient payment [6], and joined the ambulatory surgery center covered-procedures list in 2021 [7]. In 2026, beneficiaries typically pay:

Inpatient Surgery (Hospital Stay):

• Medicare Part A deductible: $1,736 in 2026, applied per benefit period (covers days 1-60 in hospital) [1]
• Includes: Surgery, implant, hospital room, meals, nursing, inpatient physical therapy
• Total out-of-pocket: $1,736 (unless you have supplemental coverage)

Outpatient Surgery (Same-Day or Next-Day Discharge):

• Medicare Part B deductible: $283 (annual deductible, 2026) [1]
• 20% coinsurance: After the deductible, you pay 20% of the Medicare-approved amount [2]
• Built-in cap: For surgery in a hospital outpatient department, your copay for the procedure cannot exceed the inpatient Part A deductible, $1,736 in 2026 [2]
• What changes the math: follow-up care adds 20% Part B coinsurance, and Medigap or Medicare Advantage coverage can lower or restructure these amounts

Looking for a dollar figure? Medicare’s Procedure Price Lookup tool shows national-average costs and patient shares by procedure code; the published knee figures (CPT 27447, knee only) put the patient share near $2,000 in either outpatient setting [9]. Check the tool for current hip-specific averages rather than trusting third-party estimates.

Additional Medicare-Covered Services:

• Pre-operative physician visits and testing
• Post-operative follow-up appointments
• Outpatient physical therapy (subject to Part B deductible and 20% coinsurance)
• Durable medical equipment like walkers, crutches, and shower chairs

Most people also pay the standard Part B premium of $202.90 per month in 2026 [1].

Medicare Advantage Plans: Advantage (Part C) plans must cover the same procedures but restructure copays and networks, so verify coverage and pre-authorization with your plan before scheduling. For a fuller walkthrough of Medicare’s rules for joint replacement, see our guide Does Medicare Cover Knee & Hip Replacement?

With Commercial Insurance: What to Expect

If you have employer-sponsored or marketplace insurance in California, the best published anchor is a 2022 analysis of commercial claims that found a mean out-of-pocket cost of $2,884 for total hip replacement, with wide variation around that mean (the standard deviation was about $2,100) [8]. Your own number depends on your plan structure.

Cost Components:

• Deductible: $1,000–$5,000 (what you pay before insurance starts covering)
• Coinsurance: 10%–30% of allowed amount (after deductible)
• Out-of-pocket maximum: varies by plan; for 2026, federal rules cap it at $10,600 for individual coverage [12]

Example Calculation: If your plan has a $2,000 deductible, 20% coinsurance, and $7,000 out-of-pocket maximum, and the allowed amount for hip replacement is $30,000:

• You pay: $2,000 (deductible) + 20% of $28,000 = $2,000 + $5,600 = $7,600
• But your cost is capped at your out-of-pocket maximum of $7,000

Critical Tip: If you haven’t met your deductible yet this year, scheduling surgery later in the year (after meeting your deductible from other medical expenses) can significantly reduce your cost.

Special Programs: California Union Health Benefits

Some union and employer health funds negotiate fixed facility rates or steer members to designated “centers of excellence” for joint replacement. If you’re covered through a union trust fund, contact your fund office and ask exactly how hip replacement is paid before you schedule surgery.

✓ Typically Covered by Medicare and Most Commercial Insurance

• Initial consultation and evaluation with your orthopedic surgeon
• Pre-operative testing: X-rays, blood work, EKG, medical clearance
• The surgery itself: Surgeon fees, anesthesia, operating room, facility charges, and the implant, which is bundled into the facility payment rather than billed to you as a separate device
• Hospital stay or recovery: Inpatient room and board, or outpatient recovery area
• Post-operative care: Follow-up appointments with your surgeon (typically 2 weeks, 6 weeks, 3 months, 1 year)
• Physical therapy: Outpatient PT sessions (subject to deductible and coinsurance)
• Durable medical equipment: Walker, crutches, shower chair, raised toilet seat
• Direct anterior hip replacement: Covered the same as any other approach; the surgical approach changes the operation, not your insurance benefits
• Robotic-assisted surgery: Usually covered at the same rate as traditional surgery (not billed separately)

✗ Typically NOT Covered (Out-of-Pocket)

• Premium implant upgrades: If you choose an upgraded implant beyond what insurance considers “standard,” you may pay the difference
• Out-of-network costs: If you choose a surgeon or facility outside your insurance network, you may pay significantly more
• Home modifications: Grab bars, stair railings, and shower benches, you purchase yourself
• Transportation to appointments: Unless you have specific coverage or qualify for medical transport benefits
• Lost wages during recovery: Insurance doesn’t cover time off work (though disability insurance might)

1. Choose Outpatient Surgery When Appropriate

Outpatient hip replacement, where you go home the same day, is now routine for appropriately selected patients, and Medicare’s payment rules allow it in hospital outpatient departments (since 2020) [6] and in ambulatory surgery centers (since 2021) [7]. The savings are real but more modest than many websites claim:

• The best published comparisons are knee data: outpatient surgery averaged $2,295 less than inpatient in commercial claims [10], and Medicare’s national averages show a $3,723 gap between hospital outpatient and surgery-center settings (CPT 27447, knee only) [9]
• Hip-specific dollar gaps are less well published, but the direction is the same: the setting moves the price

What I tell my patients: choose the setting because it’s safe for you, with the savings as a side effect, never the other way around. Heart and lung health, bone quality, weight, and home support determine candidacy at your pre-operative evaluation.

2. Stay In-Network

Using an in-network surgeon and facility can save you thousands compared to going out-of-network. Before scheduling:

• Verify your surgeon is in-network
• Verify the facility (hospital or surgery center) is in-network
• Verify the anesthesia group is in-network
• Get pre-authorization from your insurance before scheduling

Our office verifies your coverage and obtains pre-authorization before anything is scheduled, so the estimate you see reflects your actual plan.

3. Time Your Surgery Strategically

If you have a high-deductible plan and haven’t met your deductible yet this year, consider:

• Late in the year: If you’ve already met your deductible from other medical expenses, you’ll pay less for surgery
• Early in the year: If you know you’ll need a hip replacement anyway, scheduling early means you hit your out-of-pocket max sooner

Important: Don’t delay medically necessary surgery solely for financial reasons. With hip arthritis in particular, delay can mean progressive stiffness, a worsening limp, and weaker hip muscles going into surgery. Discuss timing with your surgeon.

4. Request a Detailed Cost Estimate

Before scheduling surgery, request a detailed written estimate that includes:

• Surgeon’s fee
• Facility fee
• Anesthesia fee
• Implant cost, confirmed as included in the facility fee
• Your expected out-of-pocket based on your specific insurance plan

The implant is nearly always bundled into the facility charge, so a quote listing it as a vague separate extra deserves scrutiny. Reputable practices provide this information upfront; a facility that refuses to give you an estimate is a red flag.

5. Compare Posted Prices Between Facilities

Price differences between California facilities are large, but they don’t follow a simple geographic rule: within one large California health system, negotiated prices for the same joint replacement ranged from about $20,000 to nearly $79,000 depending on the payer [4]. Prices can vary that much between facilities in the same region, so the useful comparison is facility-to-facility, not county-to-county.

Every hospital is required to post its negotiated rates and its discounted cash price online, free of charge [3]. If your insurance allows a choice of facility, comparing posted prices at two or three in-network options before you schedule can meaningfully change what you pay.

Dr. Zalikha practices in Long Beach with access to two surgical facilities, MemorialCare Long Beach Medical Center for inpatient surgery and the Surgery Center of Long Beach for outpatient surgery, so the surgical setting can be matched to your health, your coverage, and your costs.

Physical Therapy Costs

Hip replacement patients often need fewer supervised therapy visits than knee patients; many do well with a short course of formal PT plus a home program. Budget per visit:

• With Medicare: after the Part B deductible, you pay 20% of the Medicare-approved amount per visit, and there is no annual cap on what Medicare pays for medically necessary outpatient therapy [11]
• With commercial insurance: a per-visit copay or coinsurance applies, so ask the clinic for its rate up front
• Your total: depends on your visit count, which your surgeon and therapist will tailor to your progress, not a fixed package

See our post-operative instructions for what recovery actually involves week by week.

Medications

• Pain medication (first 2–3 weeks): $20–$100
• Blood thinner (if prescribed): $30–$200 depending on type
• Antibiotics (if needed): $10–$40

Home Equipment and Modifications

• Walker or crutches: $30–$100 (often covered by insurance)
• Raised toilet seat: $20–$50
• Shower chair: $30–$80
• Reacher/grabber and sock aid: $15–$40 (the most-used purchase after hip surgery)
• Ice machine (optional): $100–$400

Total equipment budget: $200–$650

Lost Income

How long you’re away from work depends mostly on what your job asks of your body: desk-based patients commonly return within a few weeks, while physically demanding jobs take considerably longer. Plan for the gap:

• Whether you have paid sick leave or vacation time
• Short-term disability insurance benefits
• California State Disability Insurance (SDI) if eligible

1. Hospital Financial Assistance Programs

Non-profit hospitals in California are required to offer financial assistance to patients based on income. Depending on your household income relative to federal poverty guidelines, you may qualify for:

• 100% discount (free care)
• 50%–75% discount
• Payment plans with no interest

Ask the hospital’s financial counselor about their charity care policy before your surgery.

2. Cash-Pay Negotiation

If you’re uninsured or your insurance won’t cover the procedure, many facilities offer discounted “cash-pay” or “self-pay” rates, often substantially less than their list charges; the posted cash price under the federal price-transparency rule is the number to ask for [3]. Request a cash-pay quote before scheduling.

3. Medical Credit Cards

CareCredit and similar medical credit cards offer 0% interest for 12–24 months on medical expenses, including surgery. This allows you to spread payments over time without interest if you pay within the promotional period.

Warning: If you don’t pay off the balance before the promotional period ends, retroactive interest (often 25%+) is applied to the entire original amount.

4. Explore Non-Surgical Options First

If cost is preventing you from moving forward, make sure you’ve exhausted the conservative options for hip arthritis:

• Physical therapy
• Weight optimization
• Corticosteroid injections
• Activity modification and a cane in the opposite hand

These are far less expensive than surgery and can buy meaningful time and comfort. I’ll be honest with you, though: they don’t rebuild cartilage, and if your hip is truly end-stage, indefinite delay carries its own costs in mobility and muscle strength.

What sets Dr. Zalikha’s practice apart:

• Transparent pricing: We provide detailed cost estimates and work with your insurance to maximize coverage
• Stanford Medicine fellowship training in adult reconstruction (joint replacement subspecialty)
• Joint replacement is the focus of the practice, not an occasional procedure
• Modern surgical techniques: Direct anterior and robotic-assisted hip replacement, with outpatient options
• Two surgical facilities in Long Beach: MemorialCare Long Beach Medical Center (inpatient) and Surgery Center of Long Beach (outpatient)
• No implant company conflicts: Dr. Zalikha accepts no payments from manufacturers
• Insurance verification and pre-authorization handled by our office before you schedule
• Evidence-based practice: Over 30 peer-reviewed publications

About Dr. Leo Zalikha
Dr. Leo Zalikha completed his orthopedic surgery residency at Wayne State University / Detroit Medical Center and his adult reconstruction fellowship at Stanford Medicine, where he also served as a Clinical Instructor. He earned his medical degree from the University of Miami Miller School of Medicine on a full-tuition merit scholarship. Learn more about Dr. Zalikha and his practice philosophy.

How much does hip replacement cost in California with Medicare?

For an inpatient hip replacement, you pay the Part A deductible of $1,736 (2026), which applies per benefit period and covers your first 60 hospital days [1]. For outpatient surgery, you pay the Part B deductible of $283 (2026) plus 20% of the Medicare-approved amount, and for hospital outpatient surgery your copay for the procedure cannot exceed the inpatient deductible [1][2]. Follow-up care adds further Part B coinsurance, and Medigap or Medicare Advantage coverage changes these amounts.

Does insurance cover hip replacement surgery in California?

Yes, hip replacement is covered by Medicare and virtually all commercial insurance plans in California when deemed medically necessary, generally after conservative treatments have been tried. You’ll still have out-of-pocket costs based on your specific plan’s deductible, coinsurance, and out-of-pocket maximum.

How much does hip replacement cost without insurance in California?

Without insurance there is no single price: hospital list prices, negotiated insurance rates, and cash prices for the same surgery differ sharply. A 2023 study of top US orthopedic hospitals found listed prices for a primary hip or knee replacement ranging from $39,927 to $195,264, with a median of $68,016 [5], while negotiated prices within one large California health system averaged $54,500 [4]. Every hospital must post its negotiated rates and its cash discount price online [3], so ask each facility for its posted cash-pay price, which is often far below the list price.

Does Medicare cover outpatient hip replacement?

Yes. Medicare removed total hip replacement from its inpatient-only list in 2020, so the surgery can be performed and paid in hospital outpatient departments [6], and added it to the ambulatory surgery center covered-procedures list in 2021 [7]. Whether outpatient hip replacement is appropriate for you is a medical decision based on your overall health and home support, not a billing choice.

Does anterior hip replacement cost more or change insurance coverage?

No. The direct anterior approach is the same operation from a billing and coverage standpoint: insurers, including Medicare, pay for total hip replacement the same way regardless of the surgical approach. The approach affects the surgical plan, not your benefits. If a facility quotes a separate surcharge for a specific approach, ask for it in writing and compare elsewhere.

What is the average out-of-pocket cost for hip replacement with commercial insurance?

A 2022 analysis of commercial insurance claims found a mean out-of-pocket cost of $2,884 for total hip replacement, with wide variation around that average [8]. Your exact cost depends on your deductible, coinsurance, and how much of your deductible you’ve already met this year; for 2026, federal rules cap individual in-network out-of-pocket maximums at $10,600 [12].

Is the hip implant billed separately from the surgery?

Not normally. The implant is bundled into the facility’s charge for the operation, so with Medicare or commercial insurance you don’t buy the implant as a separate line item. If you’re paying cash, confirm in writing that the quoted price includes the implant; a quote that excludes it is not a complete price.

Does Medicare Advantage cover hip replacement differently from Original Medicare?

Medicare Advantage plans must cover everything Original Medicare covers, but your out-of-pocket costs may be different. Many Medicare Advantage plans have lower copays for surgery, but may restrict which surgeons and facilities you can use. Always verify coverage and get pre-authorization before scheduling hip replacement with a Medicare Advantage plan.

Ready to Understand Your Costs?

A consultation with Dr. Zalikha includes a detailed cost estimate based on your specific insurance coverage. We’ll walk you through exactly what you’ll pay before you commit to surgery.

📞 Call (562) 362-5024 for Cost Estimate

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