Procedures Covered by Medicare

Knee or Hip Replacement

One of the most common and painstaking procedures Seniors on Medicare will undertake is a joint replacement such as knee or hip replacement.  According to CMS, hundreds of thousands of Seniors annually undertake these procedures across the country and most of them are probably unaware of some of the ramifications in terms of expenditures for medical and non-medic al expenses alike.

Medicare Parts A and B approve charges related to knee replacement surgery but, only if all other medical approved options have been exhausted.  Assuming the replacement surgery becomes the only viable option, Medicare Part A coverage is generally limited to the part A deductible. This means that in order to have the bulk of the expense for replacement surgery covered, this claim would need to be coded as outpatient instead of inpatient.  

Part B, which is your Medical insurance portion under Medicare, will pay an applicable co insurance percentage for Medicare approved charges subject to the annual part B deductible of 185.00 for 2019. These charges would cover things like: the surgery, anesthesiologist charges, rehabilitation charges, and the like.

Medicare Supplements or Advantage Plans Could Help Cover Expenses Related to Knee Replacement Surgery

Medicare Supplement insurance plans are designed to go behind your original Medicare and help cover some of the expenses left off by original Medicare for Medicare Part A and B approved charges.  So, a supplement plan may be ideal to assist you in gaping the 20% coinsurance left off by Medicare and could assist in paying some or all of these expenses left off by Medicare for a replacement procedure.  What’s more, a Medicare Advantage plan could also assist in covering all but a few reasonable co pays or co insurance amounts in the event of a knee replacement surgery. However, Medicare Advantage plans have varying degrees of cost sharing and do not always cover the same amounts that original Medicare covers and are networked policies.

Medicare May Cover a Medical Related Event, But Custodial Care is Typically Not Covered

Between Medicare and your supplemental insurance plan, you may get by with paying little if any for medically necessary surgeries like knee replacements.  However, what most people fail to realize is custodial care is rarely covered under original Medicare or Medicare Advantage plans.

Suppose you live alone and following a knee surgery need assistance with activities of daily living.  Most people would automatically assume Medicare would cover a home health nurse to come in and prepare meals, feed the dog, and bathe you. The bad news is none of these custodial visits are covered under Medicare!

Fortunately the insurance industry has recognized the need for supplemental products designed to cover custodial for recoveries whether they be in the home or in a confined setting.  These policies are designed to be cost effective alternatives for Seniors’ who have failed to plan for long term care expenses by way of a traditional long term care policy. Moreover these plans are portable and are typically written on an issue age basis.

This means the rates do not increase as you age so, a 65 year old would still be paying the same rate for this coverage when they are 95 year old.  Of course the insurance carriers could request a rate increase from the Insurance Department but, these increases are infrequent at most.

Learn More About Common Surgeries Covered by Medicare

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