Does Medicare Cover Hip Replacement in 2026? Costs by Setting, Rehab and What to Ask
Yes. Medicare covers hip replacement in 2026 when your doctor says it’s medically necessary. What you pay depends on where it’s done. If you’re admitted as an inpatient, Part A applies, with a $1,736 deductible per benefit period. If you’re an outpatient, at a hospital or a surgery center, Part B applies: 20% of the Medicare-approved amount after the $283 yearly deductible (Medicare.gov costs).
Many people now go home the same day or the next morning after a hip replacement. That shift changes who pays and how much. Here is how it works, step by step.
Inpatient, outpatient or surgery center?
Medicare took total hip replacement off its “inpatient-only” list on January 1, 2020. A year later, on January 1, 2021, CMS also let surgery centers (ASCs) do it (CMS 2021 outpatient rule fact sheet). Your surgeon decides the setting based on your health.
As a hospital inpatient (Part A):
- $1,736 deductible for each benefit period
- $0 for days 1 to 60 in the hospital
- Your surgeon and anesthesia are billed under Part B: 20% after the deductible
As a hospital outpatient (Part B):
- 20% of the approved amount after the $283 deductible
- A hospital copay for each service, which Medicare says usually can’t be more than the Part A deductible
- Staying overnight doesn’t make you an inpatient
At a surgery center (Part B):
- 20% of the approved amount after the $283 deductible
- Often the lowest total bill for healthy patients
The question to ask: “Will I be admitted as an inpatient, or am I an outpatient?” A night in a hospital bed under observation still counts as outpatient. That affects your costs and your right to nursing home rehab later. Our observation status guide explains how to protect yourself.
What changed in 2026
More surgeries can be outpatient. In its 2026 outpatient rule, CMS began a 3-year phase-out of the whole inpatient-only list, starting with 285 services, most of them bone and joint procedures (CMS 2026 fact sheet).
The TEAM model. Since January 1, 2026, hundreds of hospitals take part in a CMS payment test called the Transforming Episode Accountability Model (CMS TEAM fact sheet). It includes hip and knee replacements. The hospital is responsible for cost and quality through 30 days after you leave. Your Medicare rights don’t change. You may see more planning for your recovery before surgery.
Who qualifies
Medicare doesn’t publish a checklist for hip replacement. It pays when the surgery is medically necessary. Your records usually show:
- Severe hip arthritis or damage on X-rays
- Pain that limits walking, stairs, sleep or daily tasks
- Other treatments that didn’t help enough, like physical therapy, weight loss, a cane or pain medicine
A hip fracture is different. It’s an emergency, and many patients are admitted as inpatients.
If you have a Medicare Advantage plan, the same surgery is covered, but expect prior authorization and network rules. Get approval in writing before you book. Your copays follow your plan, up to its yearly out-of-pocket limit.
Rehab after surgery
Physical therapy at home or in a clinic (Part B). You pay 20% after the deductible. There’s no hard cap. Once your PT and speech therapy costs pass $2,480 in 2026, your therapist must confirm it’s still medically necessary. See our physical therapy coverage guide.
Home health. If you’re homebound after surgery, Medicare home health can send a therapist to your home for $0.
A skilled nursing facility (SNF). Medicare covers rehab in a nursing home only after a 3-day inpatient hospital stay. In 2026 you pay $0 for days 1 to 20 and $217 a day for days 21 to 100. Outpatient surgery doesn’t start this benefit. Read our skilled nursing guide.
Equipment: what’s covered and what isn’t
Medicare Part B covers a walker, cane or wheelchair when your doctor orders it and the supplier takes Medicare. You pay 20%.
But CMS’s equipment rules list raised toilet seats as a convenience item that Medicare doesn’t cover (CMS NCD 280.1). Bath seats and grab bars are also denied. After a hip replacement, your surgeon may ask you to avoid deep bending for a while, so plan to buy these yourself. A bedside commode can be covered if you’re confined to your room.
What a hip replacement may cost you
| Your coverage | Likely out-of-pocket for surgery |
|---|---|
| Original Medicare only, inpatient | $1,736 Part A deductible plus 20% of doctor bills |
| Original Medicare only, outpatient | 20% of approved amounts plus the $283 deductible |
| Original Medicare plus Medigap Plan G | Usually only the $283 Part B deductible |
| Medicare Advantage | Plan copays, up to the plan’s yearly limit |
Original Medicare alone has no yearly cap. That’s why many people add a Medigap plan.
My checklist before surgery
- Ask your surgeon: inpatient, hospital outpatient or surgery center? Why?
- Ask for a cost estimate from the hospital or surgery center.
- If you have Medicare Advantage, get prior approval in writing.
- Set up rehab before surgery: home health, outpatient PT or a SNF.
- Buy a raised toilet seat and a reacher ahead of time.
- Make your home safe from falls. Our balance exercises can help after your surgeon clears you.
Having a knee done too? Our Medicare knee replacement guide covers the same rules for knees.
Common questions
How much does Medicare pay for a hip replacement in 2026?
Medicare pays most of it. As an inpatient you pay the $1,736 Part A deductible. As an outpatient you pay 20% after the $283 Part B deductible, plus a hospital copay.
Is hip replacement inpatient or outpatient under Medicare?
It can be either. Medicare took hip replacement off its inpatient-only list in 2020 and allowed surgery centers to do it in 2021. Your surgeon picks the setting.
Does Medicare cover rehab in a nursing home after hip surgery?
Only if you had a 3-day inpatient stay. Then you pay $0 for days 1 to 20 and $217 a day for days 21 to 100 in 2026.
Does Medicare pay for a raised toilet seat after hip replacement?
No. CMS lists raised toilet seats as a convenience item. A walker or bedside commode can be covered when medically needed.
Does Medicare Advantage cover hip replacement?
Yes, but most plans need prior authorization and require in-network surgeons and hospitals. Costs follow your plan’s copays.
Written by Khasim Basha Shaik. I research Medicare coverage rules for readers. I am not a doctor or licensed insurance agent. This article summarizes Medicare.gov and CMS materials and is not medical advice. Last reviewed October 17, 2026.
