Medicare Coverage for Knee Replacement in New Mexico
| 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 (Knee Replacement) | $22,800 |
| Medicare Beneficiaries in New Mexico | 440,000 |
Does Medicare Cover Knee Replacement in New Mexico?
Yes — Medicare covers knee replacement treatment in New Mexico under both Part A (hospital/inpatient) and Part B (outpatient/physician services). The average annual Medicare cost for Knee Replacement is approximately $22,800, with Medicare paying 80% of approved charges after the Part B deductible ($240 in 2026).
What Medicare Covers for Knee Replacement in New Mexico
- total knee 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 Knee Replacement in New Mexico
Under Original Medicare in New Mexico, you pay 20% of all Part B-covered knee 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 New Mexico Medicare beneficiary with knee replacement pays approximately $4,560/year in out-of-pocket costs under Original Medicare.
Cost Comparison: Original Medicare vs. Medicare Advantage for Knee Replacement in New Mexico
| Coverage Type | Annual Out-of-Pocket (Estimated) | Out-of-Pocket Maximum | Prescription Coverage |
|---|---|---|---|
| Original Medicare (Parts A+B) | $4,560 | No limit | Separate Part D plan required |
| Original Medicare + Medigap Plan G | $1,380 + $1,392 Medigap premiums | Effectively capped | Separate Part D plan required |
| Medicare Advantage (avg in New Mexico) | Varies by plan | Capped (varies) | Usually included |
Medicare Advantage Coverage for Knee Replacement in New Mexico
Medicare Advantage plans in New Mexico must cover all services that Original Medicare covers for knee replacement, but may have different cost-sharing structures. With 18 MA plans available in New Mexico, you can compare plans specifically for their knee replacement coverage, including specialist networks, prior authorization requirements, and drug formularies. The average MA plan in New Mexico is rated 3.8 stars by CMS.
Medicare Part D Coverage for Knee Replacement Medications in New Mexico
Most medications for knee replacement are covered under Medicare Part D in New Mexico. Check individual plan formularies at medicare.gov/plan-compare for specific drug coverage and tier placement.
Medicaid and Knee Replacement in New Mexico
New Mexico 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 New Mexico with knee replacement, Medicaid covers Medicare cost-sharing (premiums, deductibles, and copays), providing comprehensive coverage with minimal out-of-pocket costs.
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