Medicare Coverage for Knee Replacement in West Virginia
| 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 West Virginia | 480,000 |
Does Medicare Cover Knee Replacement in West Virginia?
Yes — Medicare covers knee replacement treatment in West Virginia 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 West Virginia
- 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 West Virginia
Under Original Medicare in West Virginia, 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 West Virginia 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 West Virginia
| 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 + $1,344 Medigap premiums | Effectively capped | Separate Part D plan required |
| Medicare Advantage (avg in West Virginia) | Varies by plan | Capped (varies) | Usually included |
Medicare Advantage Coverage for Knee Replacement in West Virginia
Medicare Advantage plans in West Virginia must cover all services that Original Medicare covers for knee replacement, but may have different cost-sharing structures. With 16 MA plans available in West Virginia, you can compare plans specifically for their knee replacement coverage, including specialist networks, prior authorization requirements, and drug formularies. The average MA plan in West Virginia is rated 3.6 stars by CMS.
Medicare Part D Coverage for Knee Replacement Medications in West Virginia
Most medications for knee replacement are covered under Medicare Part D in West Virginia. Check individual plan formularies at medicare.gov/plan-compare for specific drug coverage and tier placement.
Medicaid and Knee Replacement in West Virginia
West Virginia 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 West Virginia 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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