How Much Does Hip Replacement Cost?
The answer to this question depends on a few things, including your insurance coverage. Read on to learn what you can expect and some strategies for managing the cost of your treatment—whether or not you have insurance.
Most insurance plans—including Medicare and Medicaid—cover hip replacement surgery. If your insurance plan covers it, your doctor will need to establish that it is medically necessary. It can help to know what exactly your doctor must document to show this. Talk to your insurance provider and ask about your coverage. Find out if your insurance only covers certain types of hip implants. Ask if you need preauthorization or any other paperwork before starting treatment.
Health insurance, Medicare, and Medicaid typically cover:
- An evaluation appointment with an orthopedic surgeon
- Pre-surgery appointments including diagnostic studies and lab tests
- The surgery including fees for the doctor, anesthesia, hip implant, and hospital operating room
- Postoperative hospitalization
- Preparation of your home for postoperative recovery with safety bars and other medical equipment
- Rehabilitation and physical therapy appointments
Make sure you understand any limits on your coverage.
The amount you will pay out-of-pocket for hip replacement surgery depends on insurance coverage. Even if your insurance covers hip replacement, you will likely be responsible for a portion of the cost. Ask your insurance provider about your costs—copays, deductibles and co-insurance—for your surgery. Supplemental insurance that closes the gap in Medicare coverage can save you plenty. Don’t forget that you can apply flexible spending account (FSA), health savings account (HAS), and health reimbursement account (HRA) funds to your out-of-pocket costs.
If you don’t have insurance and will be paying for your hip replacement, do your homework. The cost of a hip replacement varies across the country and from hospital to hospital. The average national price for a hip replacement in 2020 was over $39,000 including the cost of the implant. Under traditional Medicare you would be responsible for your annual deductible plus the 20% copayment which would likely be covered by a Medicare supplement (Medigap) policy.
Your choice of hospital is the biggest factor in the cost of your hip replacement. There can be a 10-fold variance in price estimates from hospital to hospital. When you compare these prices, make sure you are comparing apples to apples. Find out if the price is for a complete bundle of all services or if it only includes certain fees. You need to know what your total cost will be and not just the hospital fee.
When pricing your surgery, make sure both the hospital and doctor know you are a self-paying patient. Many providers offer a discount for people who are paying for their own healthcare. But you have to ask for it because they usually don’t tell you this upfront. Find out if you can finance the cost or break your payments into chunks. You can also use FSA, HSA and HRA funds to help pay for surgery.
The saying “you get what you pay for” holds true in healthcare. Don’t automatically go with the lowest cost option. Consider each doctor’s experience, expertise, and patient satisfaction, too. You also need to look at the quality of care at the hospital where your hip replacement will take place. You can find this information on Healthgrades.com.