Knee Replacement Cost in California: What Insurance Covers

You’ve been told you need knee replacement surgery. The surgeon thinks it’s time. Your imaging shows bone-on-bone arthritis. You’re ready to move forward, but now comes the question everyone asks: “How much is this actually going to cost me?”

If you live in California, the answer depends on several factors: where you have surgery, what type of insurance you have, whether you choose inpatient or outpatient, and whether you qualify for certain cost-saving programs. This guide breaks down exactly what California patients pay and how to make sure you’re not overpaying.

Quick Summary :
In California, what you pay for a knee replacement depends less on your region than on the specific facility 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, the national-average patient share for outpatient surgery is $1,967 in a hospital outpatient department or $2,109 in a surgery center [2]; an inpatient stay involves the $1,736 Part A deductible (2026, per benefit period) [1]. With commercial insurance, published averages are roughly $2,500–$3,000 out-of-pocket and rising [7][8]. Outpatient surgery does cost less than inpatient ($2,295 in commercial claims data; $3,723 between Medicare settings), not the five-figure savings often advertised [2][6].

Without Insurance: Total Cost Ranges

If you’re paying without insurance, the most important thing to understand is that there is no single price. The list (chargemaster) price, the negotiated insurance rate, and the cash price for the same surgery are different numbers, and the gaps between them are large. 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
• 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]. Variation between facilities in the same region can be as large as variation between regions, 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 the posted prices for each facility you’re considering before you schedule.

With Medicare: 2026 Out-of-Pocket Costs

Medicare covers knee replacement surgery when deemed medically necessary. In 2026, California Medicare 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, hospital room, meals, nursing, inpatient physical therapy
• Total out-of-pocket: $1,736 (unless you have supplemental coverage)

Outpatient Surgery (Same-Day Discharge):

• Medicare Part B deductible: $283 (annual deductible, 2026) [1]
• 20% coinsurance: After the deductible, you pay 20% of the Medicare-approved amount
• National-average patient share: $1,967 for surgery in a hospital outpatient department, $2,109 in an ambulatory surgery center [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

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

Medicare Advantage Plans: If you have Medicare Advantage (Part C), your costs may differ. Many plans have lower copays but may restrict which surgeons and facilities you can use. Always verify coverage with your specific plan before scheduling.

With Commercial Insurance: What to Expect

If you have employer-sponsored or marketplace insurance in California, published claims analyses put the average out-of-pocket cost for knee replacement at roughly $2,500–$3,000, and those costs have been rising; high-deductible plans can run substantially higher [7][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 knee 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 knee or hip replacement is paid before you schedule surgery.

Check with your employer or union to see if similar programs are available to you.

✓ Typically Covered by Medicare and Most Commercial Insurance

• Initial consultation and evaluation with your orthopedic surgeon
• Pre-operative testing: X-rays, MRI if needed, blood work, EKG, medical clearance
• The surgery itself: Surgeon fees, anesthesia, operating room, implant, hospital/facility charges
• 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
• Robotic-assisted surgery: Usually covered at the same rate as traditional surgery (not billed separately)

✗ Typically NOT Covered (Out-of-Pocket)

• Premium implants: 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 knee replacement, where you go home the same day, is now standard for appropriately selected patients. The savings are real, though smaller than many websites claim:

• Commercial claims data: outpatient surgery averaged $2,295 less than inpatient at the time of surgery, and $2,679 less over the full 90-day episode [6]
• Medicare national averages (CPT 27447): $14,275 in a hospital outpatient department versus $10,552 in an ambulatory surgery center, a $3,723 difference [2]
• One caveat: under Medicare, the patient’s own copay averages slightly more in a surgery center ($2,109) than in a hospital outpatient department ($1,967) [2]

Whether you’re a candidate for outpatient surgery depends on your overall health, home support system, and the complexity of your case. Discuss this with your surgeon during your consultation.

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

Dr. Zalikha’s practice accepts Medicare and most major commercial insurance plans. We verify coverage and obtain pre-authorization as part of our standard process.

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 knee replacement anyway, scheduling early means you hit your out-of-pocket max sooner

Important: Don’t delay medically necessary surgery solely for financial reasons. Delaying can lead to muscle atrophy and a more difficult recovery. 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
• Your expected out-of-pocket based on your specific insurance plan

Reputable practices provide this information upfront. If a facility refuses to give you a cost estimate, that’s 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, an inpatient hospital and an outpatient surgery center, so the surgical setting can be matched to your health, your coverage, and your costs.

Physical Therapy Costs

Most patients complete 12–16 weeks of outpatient physical therapy after knee replacement. With insurance:

• Typical schedule: 2–3 times per week for 12–16 weeks = 24–48 sessions
• 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]
• Your total: depends on your visit count and your plan’s per-visit copay or coinsurance, so ask the clinic for its rate up front

Learn more about knee replacement recovery and what to expect.

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
• Grabber/reacher tool: $10–$25
• Ice machine (optional): $100–$400

Total equipment budget: $200–$650

Lost Income

In a systematic review, the average time to return to work after knee replacement ranged from 8 to 12 weeks, with 71–83% of patients back at work within 3 to 6 months [10], and your timeline will depend heavily on how physically demanding your job is. Consider:

• 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 all conservative treatment options:

• Physical therapy
• Weight optimization
• Corticosteroid injections
• Hyaluronic acid injections
• PRP and biologic injections

These treatments are significantly less expensive than surgery and may provide enough relief to delay or avoid knee replacement.

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: Robotic-assisted surgery and 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
• Medicare and most major insurance accepted
• 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 knee replacement cost in California with Medicare?

With Medicare, for inpatient surgery you pay the Part A deductible of $1,736 (2026), which applies per benefit period [1]. For outpatient surgery, you pay the Part B deductible of $283 (2026) plus 20% coinsurance; the national-average patient share is $1,967 in a hospital outpatient department and $2,109 in an ambulatory surgery center [2]. Follow-up care adds further Part B coinsurance, and Medigap or Medicare Advantage coverage changes these amounts. Medicare also covers pre-operative testing, follow-up care, and physical therapy (subject to Part B deductible and coinsurance).

Does insurance cover knee replacement surgery in California?

Yes, knee replacement is covered by Medicare and virtually all commercial insurance plans in California when deemed medically necessary 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 knee 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.

Is outpatient knee replacement cheaper than inpatient?

Yes, outpatient knee replacement at an ambulatory surgery center does cost less, but the documented difference is more modest than many websites suggest: a 2023 analysis of US commercial claims found outpatient surgery cost $2,295 less at the time of surgery and $2,679 less over the 90-day episode [6], and Medicare’s national averages show a $3,723 gap between hospital outpatient and surgery-center settings [2]. However, not all patients are appropriate candidates for outpatient surgery. This is determined during your pre-operative evaluation based on your overall health and home support system.

Does robotic knee replacement cost more in California?

At most in-network facilities in California, robotic-assisted knee replacement is covered at the same rate as traditional surgery, it’s not billed as a separate upgrade. Robotic assistance does add cost on the facility side, about $2,941 more per case in one study of high-volume surgeons [9], but whether any of that reaches your bill varies by facility. If you’re paying cash, ask the facility directly whether robotic assistance changes your price.

What is the average out-of-pocket cost for knee replacement with commercial insurance in California?

With commercial insurance, published claims analyses report average out-of-pocket costs of roughly $2,500–$3,000 for knee replacement, and those costs have been rising; high-deductible plans run higher [7][8]. Your exact cost depends on your deductible (typically $1,000–$5,000), coinsurance (usually 10%–30% of the allowed amount), and whether you’ve already met your deductible from other medical expenses this year.

Does Medicare Advantage cover knee 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 knee replacement with a Medicare Advantage plan.

Can I negotiate the cost of knee replacement surgery in California?

If you’re self-pay (no insurance), yes, many facilities offer discounted cash-pay rates that are often substantially less than list charges; the posted cash price is the number to ask for [3]. Request written quotes from multiple facilities and ask specifically about cash-pay discounts. If you have insurance, negotiation is limited because facilities have contracted rates with insurers. However, you can still shop for the most cost-effective in-network option.

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

2760 Atlantic Ave, Long Beach, CA 90806  ·  Mon–Fri 8 AM–5 PM

Book your consultation online →  |  Visit our Long Beach office