Medicare Coverage for Hip Replacement in North Carolina
| Medicare Part A Coverage | Yes — hospital and inpatient care |
|---|---|
| Medicare Part B Coverage | Yes — 80% after deductible |
| Medicare Part D Coverage | Not applicable |
| Your Cost Share (Part B) | 20% after $240 deductible |
| Average Annual Medicare Cost (Hip Replacement) | $24,600 |
| Medicare Beneficiaries in North Carolina | 2,180,000 |
Does Medicare Cover Hip Replacement in North Carolina?
Yes — Medicare covers hip replacement treatment in North Carolina under both Part A (hospital/inpatient) and Part B (outpatient/physician services). The average annual Medicare cost for Hip Replacement is approximately $24,600, with Medicare paying 80% of approved charges after the Part B deductible ($240 in 2026).
What Medicare Covers for Hip Replacement in North Carolina
- total hip replacement surgery
- hospital stay
- anesthesia
- physical therapy
- skilled nursing facility (up to 100 days)
- home health care
- durable medical equipment
Your Out-of-Pocket Costs for Hip Replacement in North Carolina
Under Original Medicare in North Carolina, you pay 20% of all Part B-covered hip replacement services after meeting the annual deductible ($240 in 2026). There is no out-of-pocket maximum under Original Medicare, which means costs can add up significantly for serious conditions. The average North Carolina Medicare beneficiary with hip replacement pays approximately $4,920/year in out-of-pocket costs under Original Medicare.
Cost Comparison: Original Medicare vs. Medicare Advantage for Hip Replacement in North Carolina
| Coverage Type | Annual Out-of-Pocket (Estimated) | Out-of-Pocket Maximum | Prescription Coverage |
|---|---|---|---|
| Original Medicare (Parts A+B) | $4,920 | No limit | Separate Part D plan required |
| Original Medicare + Medigap Plan G | $1,470 + $1,512 Medigap premiums | Effectively capped | Separate Part D plan required |
| Medicare Advantage (avg in North Carolina) | Varies by plan | Capped (varies) | Usually included |
Medicare Advantage Coverage for Hip Replacement in North Carolina
Medicare Advantage plans in North Carolina must cover all services that Original Medicare covers for hip replacement, but may have different cost-sharing structures. With 54 MA plans available in North Carolina, you can compare plans specifically for their hip replacement coverage, including specialist networks, prior authorization requirements, and drug formularies. The average MA plan in North Carolina is rated 3.9 stars by CMS.
Medicare Part D Coverage for Hip Replacement Medications in North Carolina
Most medications for hip replacement are covered under Medicare Part D in North Carolina. Check individual plan formularies at medicare.gov/plan-compare for specific drug coverage and tier placement.
Medicaid and Hip Replacement in North Carolina
North Carolina has fully expanded Medicaid under the Affordable Care Act, meaning adults earning up to 138% of the Federal Poverty Level ($22,025/year for an individual) qualify for Medicaid coverage. For dual-eligible individuals in North Carolina with hip replacement, Medicaid covers Medicare cost-sharing (premiums, deductibles, and copays), providing comprehensive coverage with minimal out-of-pocket costs.
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