Medicare Coverage for Hip Replacement in Pennsylvania
| 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 Pennsylvania | 3,080,000 |
Does Medicare Cover Hip Replacement in Pennsylvania?
Yes — Medicare covers hip replacement treatment in Pennsylvania 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 Pennsylvania
- 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 Pennsylvania
Under Original Medicare in Pennsylvania, 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 Pennsylvania 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 Pennsylvania
| 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 + $1,776 Medigap premiums | Effectively capped | Separate Part D plan required |
| Medicare Advantage (avg in Pennsylvania) | Varies by plan | Capped (varies) | Usually included |
Medicare Advantage Coverage for Hip Replacement in Pennsylvania
Medicare Advantage plans in Pennsylvania must cover all services that Original Medicare covers for hip replacement, but may have different cost-sharing structures. With 62 MA plans available in Pennsylvania, you can compare plans specifically for their hip replacement coverage, including specialist networks, prior authorization requirements, and drug formularies. The average MA plan in Pennsylvania is rated 4.0 stars by CMS.
Medicare Part D Coverage for Hip Replacement Medications in Pennsylvania
Most medications for hip replacement are covered under Medicare Part D in Pennsylvania. Check individual plan formularies at medicare.gov/plan-compare for specific drug coverage and tier placement.
Medicaid and Hip Replacement in Pennsylvania
Pennsylvania 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 Pennsylvania 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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