Yes, Medicare covers medically necessary hip replacements, plus much of the rehab that follows.
This 2026 guide explains which part of Medicare pays, what it costs, how recovery care works and the one piece of recovery Medicare won’t cover that every family should plan for.
Key Takeaways
- Yes, Medicare covers medically necessary hip replacement surgery. Coverage falls under Part A (inpatient) or Part B (outpatient).
- Your costs: the Part A hospital deductible for an inpatient stay, or the Part B deductible plus a 20% coinsurance for outpatient surgery.
- Recovery is covered too: skilled home health, skilled nursing facility rehab (up to 100 days), and outpatient physical therapy.
- Medicare also helps with equipment like a walker or raised toilet seat (durable medical equipment, 20% coinsurance).
- Not covered: the non-medical daily help many patients need after surgery: bathing, dressing, meals, and housekeeping services.
- That recovery gap is filled by private-pay or Medicaid home care.
- NYC families: All Heart Homecare provides safe post-surgery recovery care at home. Contact us to plan your loved one’s recovery.
Does Medicare Cover Hip Replacement Surgery?
Yes. Medicare covers hip replacement recovery (total hip arthroplasty) when your doctor determines it’s medically necessary: typically due to severe arthritis, a fracture, or joint damage that limits mobility and hasn’t responded to other treatment. Age isn’t a barrier; the deciding factor is medical necessity.
What changes your costs is where the surgery happens, as a hospital inpatient or as an outpatient procedure, because that determines whether Part A or Part B pays.
Which Part of Medicare Pays: Part A vs. Part B?
Since hip replacement was removed from Medicare’s “inpatient-only” list, it can be done either way, and the setting drives your coverage.
Inpatient Hip Replacement (Part A)
If you’re formally admitted as a hospital inpatient, Medicare Part A covers the hospital stay: the room, nursing, and related services, after you meet the annual Part A hospital deductible (set each year; it was $1,676 in 2025).
Outpatient Hip Replacement (Part B)
Many hip replacements are now done as outpatient procedures. In that case, Medicare Part B covers the surgery, surgeon’s fee, and related outpatient services. You pay the Part B deductible and then a 20% coinsurance of the Medicare-approved amount.
Tip: Ask your surgeon whether the procedure will be billed as inpatient or outpatient; it affects both your costs and your eligibility for skilled nursing facility rehab afterward.
How Much Does Medicare Pay for Hip Replacement?
Your out-of-pocket cost depends on the setting and any supplemental coverage:
- Inpatient: Part A pays after the hospital deductible;
- Outpatient: Part B pays 80% after its deductible, leaving you a 20% coinsurance;
- Equipment: Part B covers durable medical equipment (walker, raised toilet seat, etc.) at 80%; and
- Supplemental plans: a Medigap policy or Medicare Advantage plan can significantly reduce these amounts.
Does Medicare Cover Recovery After Hip Replacement?
Yes, recovery is where Medicare does a lot of good. Depending on your needs, it covers:
Skilled Home Health and Physical Therapy at Home
If you’re homebound and need skilled care, Medicare covers home health after your hip replacement, skilled nursing plus physical and occupational therapy to help you walk safely and regain strength.
See Medicare home health services and our post-surgery home care guide.
Skilled Nursing Facility (SNF) Rehab
If you had a qualifying 3-day inpatient hospital stay and need daily skilled care, Medicare covers up to 100 days of rehab in a skilled nursing facility (days 1–20 in full; days 21–100 with a coinsurance). Details on the Medicare SNF care page, and more in our nursing home coverage guide.
Outpatient Physical Therapy
Once you’re able to travel, Medicare Part B outpatient physical therapy is covered at 80% after the deductible, for as long as it’s medically necessary.
What Medicare does NOT cover after hip replacement
Here’s the gap families are caught off guard by. After a hip replacement, most people can’t safely bathe, dress, cook, or move around the home unassisted for weeks — but Medicare doesn’t pay for that non-medical help. Specifically, it won’t cover:
- Custodial/personal care (bathing, dressing, toileting) when no skilled care is involved;
- Homemaker help like cooking, cleaning, and laundry;
- 24-hour or overnight supervision during early recovery; and
- Transportation and companionship.
This is the same skilled-vs-custodial rule explained in Does Medicare Cover Custodial & Personal Care? and it’s exactly the help post-surgery home care provides.
Preventing a fall during recovery is critical; see our falls-prevention tips.
Does Medicare Advantage Cover Hip Replacement?
Yes. Medicare Advantage (Part C) plans must cover everything Original Medicare covers, including a medically necessary hip replacement. The differences are in the details: plans often require prior authorization, use specific hospital and surgeon networks, and set their own copays. Some also add extras like transportation or limited in-home support.
Always confirm the requirements with your plan before scheduling surgery.
If Medicare Won’t Cover the Home Help, Who Pays?
For the daily, non-medical help you’ll need during recovery, New York families rely on:
- Private pay. The most flexible option: schedule a caregiver for exactly the hours you need during recovery, including around-the-clock (24-hour) care for the first days home. Explore private pay home care.
- Medicaid. For those who qualify financially, Medicaid can cover ongoing personal care at home. See our Medicaid home care page.
- Long-term care insurance. Some policies reimburse in-home recovery care; check the terms.
- Veterans benefits. The VA Aid & Attendance pension can help eligible veterans and spouses.
What Medicare Covers vs. What You’ll Need After Surgery
A quick snapshot of the recovery gap:
| Medicare covers | Medicare does NOT cover |
| The surgery (Part A or Part B) | Bathing, dressing, toileting help |
| Skilled home health nursing | Cooking, cleaning, laundry |
| Physical & occupational therapy | 24-hour or overnight supervision |
| SNF rehab (if you qualify) | Transportation & companionship |
| Durable medical equipment | Non-medical personal care alone |
How Much Does Home Care After Hip Replacement Cost in NYC?
Recovery help is billed hourly, so you pay only for what you need, often more in the first week or two, then tapering off.
For current 2026 figures, see our Home Care Costs in 2026: NYC Pricing Guide.
How To Plan a Safe Hip Replacement Recovery at Home
- Confirm coverage before surgery. Ask whether the procedure is inpatient or outpatient, and check any Medicare Advantage prior-authorization rules.
- Arrange the skilled care. Line up Medicare-covered home health or SNF rehab and outpatient physical therapy.
- Fill the daily-help gap. Add private-pay or Medicaid home care for bathing, meals, and mobility support Medicare won’t cover.
- Fall-proof the home. Remove trip hazards and set up equipment before your loved one comes home. See our home care after hospital discharge checklist.
- Get a professional care assessment. A local agency can coordinate skilled and non-skilled recovery care and match each to the right funding.
Frequently Asked Questions About Medicare Coverage for Hip Replacement
Does Medicare cover hip replacement surgery?
Yes. Medicare covers medically necessary hip replacement surgery when a doctor confirms it is needed. Depending on whether the surgery is inpatient or outpatient, it is covered under Medicare Part A or Part B, and you are responsible for the applicable deductible and coinsurance.
Does Medicare cover hip replacement for seniors?
Yes. Medicare covers medically necessary hip replacement for eligible seniors, whether the procedure is done as an inpatient hospital stay (Part A) or an outpatient surgery (Part B). Age alone does not disqualify a patient; the surgery must be medically necessary.
How much does Medicare pay for hip replacement?
For an inpatient hip replacement, Part A pays after you meet the annual hospital deductible. For an outpatient hip replacement, Part B generally pays 80% of the approved amount after the Part B deductible, leaving you a 20% coinsurance. A Medigap or Medicare Advantage plan can reduce these out-of-pocket costs.
Does Medicare cover physical therapy after hip replacement?
Yes. Medicare covers medically necessary physical therapy after a hip replacement — as skilled home health therapy if you are homebound, in a skilled nursing facility if you qualify, or as outpatient therapy under Part B with a 20% coinsurance.
Does Medicare cover home care after hip replacement?
Medicare covers skilled home health care after a hip replacement, such as nursing and physical or occupational therapy, if you are homebound and a doctor orders it. It does not cover non-medical help alone, like bathing, dressing, meals, or housekeeping, which many patients also need during recovery.
Does Medicare cover a skilled nursing facility after hip replacement?
It can. If you have a qualifying inpatient hospital stay of at least 3 days and need daily skilled care, Medicare covers up to 100 days in a skilled nursing facility per benefit period, with full coverage for days 1 to 20 and a daily coinsurance for days 21 to 100.
Does Medicare Advantage cover hip replacement?
Yes. Medicare Advantage plans must cover everything Original Medicare covers, including medically necessary hip replacement. Plans may require prior authorization and use specific provider networks, and your costs and rules can differ, so check with your plan before surgery.
