If your doctor has recommended hip replacement surgery, your first question is probably: does Medicare cover hip replacement in 2026? The answer is yes — Medicare provides substantial coverage for this life-changing procedure. More than 450,000 hip replacements are performed annually in the U.S., and understanding exactly what Medicare pays could save you thousands of dollars.
Does Medicare Cover Hip Replacement in 2026?
Medicare covers total hip replacement (THR) and partial hip replacement (hemiarthroplasty) when medically necessary. Coverage depends on whether surgery is classified as inpatient (Part A) or outpatient (Part B). The American Academy of Orthopaedic Surgeons reports hip replacement has a 95%+ long-term success rate.
Medicare Hip Replacement Coverage 2026: Cost Table
| Setting | Medicare Part | 2026 Cost to You |
|---|---|---|
| Inpatient hospital admission | Part A | $1,736 deductible; $0/day days 1–20 |
| Outpatient hospital / ASC | Part B | $283 deductible + 20% coinsurance |
| Skilled nursing facility rehab | Part A | $0/day days 1–20; $194.50/day days 21–100 |
The Critical Observation Status Trap
One of the most important distinctions for Medicare hip replacement coverage in 2026 is observation status. If your hospital designates you as an observation patient rather than formally admitted, your surgery bills under Part B — not Part A — and you lose your SNF rehabilitation benefit (which requires a 3-night qualifying inpatient stay). Always ask your surgeon and hospital in advance: “Will I be formally admitted as an inpatient?” Request inpatient status in writing if you expect to need post-surgical SNF rehabilitation.
What Does Medicare Cover for Hip Replacement?
- Pre-operative labs, X-rays, MRI/CT imaging
- Anesthesia and surgical fees
- Hip implant device (prosthetic joint components)
- Hospital room and nursing care during inpatient admission
- Physical and occupational therapy during hospital stay
- Post-discharge SNF care (up to 100 days after qualifying 3-night stay)
- Outpatient physical therapy with no annual cap
- Follow-up physician visits under Part B
Hip Replacement Cost With Medicare 2026: Comparison Table
| Cost Component | Original Medicare Only | With Medigap Plan G |
|---|---|---|
| Part A Hospital Deductible | $1,736 | $0 |
| SNF Days 21–100 | Up to $19,450 | $0 |
| Part B Surgeon/Anesthesia (20%) | ~$1,500–$3,000 | $0 |
| Outpatient Rehab (20%) | Varies | $0 |
| Total Estimated OOP | $3,000–$25,000+ | ~$283 only |
With Medigap Plan G, Medicare pays 80% of all approved charges and Plan G covers the remaining 20% coinsurance plus the Part A deductible. Your only expense would be the $283 Part B annual deductible — if not already met.
Medicare Advantage and Hip Replacement
Medicare Advantage (Part C) plans require prior authorization for hip replacement — submit your PA request with surgical documentation 2–4 weeks before surgery. Network restrictions apply. The 2026 in-network MOOP cap is $9,250; once reached, the plan covers 100% of covered services for the remainder of the year.
Who Qualifies for Medicare Hip Replacement Coverage?
Medicare requires documented medical necessity: severe hip arthritis (osteoarthritis, rheumatoid arthritis, or avascular necrosis) significantly limiting daily activities; failed conservative treatment (PT, anti-inflammatory medications, steroid injections, assistive devices); significant pain or functional impairment not manageable non-surgically; or hip fracture requiring surgical repair.
5 Steps to Prepare for Medicare-Covered Hip Replacement
- Verify Medicare-approved providers at medicare.gov/care-compare
- Request formal inpatient admission status in writing before surgery
- Get prior authorization if on Medicare Advantage — submit 2–3 weeks before surgery
- Review Medigap coverage — Plan G reduces total exposure to ~$283
- Identify Medicare-certified SNFs near you and check availability before your surgery date
Common Questions About Medicare Hip Replacement
Does Medicare cover bilateral hip replacement? Yes, Medicare can cover simultaneous bilateral hip replacement when medically appropriate, with higher associated costs. Does Medicare cover hip revision surgery? Yes — same coverage rules as primary hip replacement. Does Medicare cover robotic-assisted hip replacement? Yes, as long as the procedure is medically necessary and performed by a Medicare-approved provider.
Sources
- Medicare.gov — Hip Replacement Coverage
- American Academy of Orthopaedic Surgeons
- CMS Medicare Coverage Database
Related Articles You May Find Helpful
- Does Medicare Cover Knee Replacement in 2026?
- Medicare Cardiac Rehabilitation Coverage 2026
- Best Medigap Plans 2026
- Fall Prevention for Seniors 2026
- Does Medicare Cover Physical Therapy in 2026?
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