Medicare Coverage for Hip Replacement in Wisconsin
| 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 Wisconsin | 1,280,000 |
Does Medicare Cover Hip Replacement in Wisconsin?
Yes — Medicare covers hip replacement treatment in Wisconsin 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 Wisconsin
- 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 Wisconsin
Under Original Medicare in Wisconsin, 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 Wisconsin 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 Wisconsin
| 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 + $1,632 Medigap premiums | Effectively capped | Separate Part D plan required |
| Medicare Advantage (avg in Wisconsin) | Varies by plan | Capped (varies) | Usually included |
Medicare Advantage Coverage for Hip Replacement in Wisconsin
Medicare Advantage plans in Wisconsin must cover all services that Original Medicare covers for hip replacement, but may have different cost-sharing structures. With 38 MA plans available in Wisconsin, you can compare plans specifically for their hip replacement coverage, including specialist networks, prior authorization requirements, and drug formularies. The average MA plan in Wisconsin is rated 4.0 stars by CMS.
Medicare Part D Coverage for Hip Replacement Medications in Wisconsin
Most medications for hip replacement are covered under Medicare Part D in Wisconsin. Check individual plan formularies at medicare.gov/plan-compare for specific drug coverage and tier placement.
Medicaid and Hip Replacement in Wisconsin
Wisconsin has partially expanded Medicaid. Adults earning up to 100% FPL may qualify, but the state has not adopted full ACA expansion to 138% FPL. For dual-eligible individuals in Wisconsin 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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