Medicare Ratings Guide

Author: Dr. Patricia Chen

  • Medicare Coverage for Hip Replacement in Washington 2026: What’s Covered & Costs

    Medicare Coverage for Hip Replacement in Washington

    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 Washington 1,480,000

    Does Medicare Cover Hip Replacement in Washington?

    Yes — Medicare covers hip replacement treatment in Washington 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 Washington

    • 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 Washington

    Under Original Medicare in Washington, 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 Washington 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 Washington

    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 + $1,824 Medigap premiums Effectively capped Separate Part D plan required
    Medicare Advantage (avg in Washington) Varies by plan Capped (varies) Usually included

    Medicare Advantage Coverage for Hip Replacement in Washington

    Medicare Advantage plans in Washington must cover all services that Original Medicare covers for hip replacement, but may have different cost-sharing structures. With 38 MA plans available in Washington, you can compare plans specifically for their hip replacement coverage, including specialist networks, prior authorization requirements, and drug formularies. The average MA plan in Washington is rated 4.1 stars by CMS.

    Medicare Part D Coverage for Hip Replacement Medications in Washington

    Most medications for hip replacement are covered under Medicare Part D in Washington. Check individual plan formularies at medicare.gov/plan-compare for specific drug coverage and tier placement.

    Medicaid and Hip Replacement in Washington

    Washington 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 Washington with hip replacement, Medicaid covers Medicare cost-sharing (premiums, deductibles, and copays), providing comprehensive coverage with minimal out-of-pocket costs.

  • Medicare Coverage for Hip Replacement in Virginia 2026: What’s Covered & Costs

    Medicare Coverage for Hip Replacement in 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 (Hip Replacement) $24,600
    Medicare Beneficiaries in Virginia 1,680,000

    Does Medicare Cover Hip Replacement in Virginia?

    Yes — Medicare covers hip replacement treatment in Virginia 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 Virginia

    • 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 Virginia

    Under Original Medicare in Virginia, 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 Virginia 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 Virginia

    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 + $1,656 Medigap premiums Effectively capped Separate Part D plan required
    Medicare Advantage (avg in Virginia) Varies by plan Capped (varies) Usually included

    Medicare Advantage Coverage for Hip Replacement in Virginia

    Medicare Advantage plans in Virginia must cover all services that Original Medicare covers for hip replacement, but may have different cost-sharing structures. With 44 MA plans available in Virginia, you can compare plans specifically for their hip replacement coverage, including specialist networks, prior authorization requirements, and drug formularies. The average MA plan in Virginia is rated 4.0 stars by CMS.

    Medicare Part D Coverage for Hip Replacement Medications in Virginia

    Most medications for hip replacement are covered under Medicare Part D in Virginia. Check individual plan formularies at medicare.gov/plan-compare for specific drug coverage and tier placement.

    Medicaid and Hip Replacement in Virginia

    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 Virginia with hip replacement, Medicaid covers Medicare cost-sharing (premiums, deductibles, and copays), providing comprehensive coverage with minimal out-of-pocket costs.

  • Medicare Coverage for Hip Replacement in Vermont 2026: What’s Covered & Costs

    Medicare Coverage for Hip Replacement in Vermont

    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 Vermont 160,000

    Does Medicare Cover Hip Replacement in Vermont?

    Yes — Medicare covers hip replacement treatment in Vermont 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 Vermont

    • 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 Vermont

    Under Original Medicare in Vermont, 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 Vermont 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 Vermont

    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 + $1,944 Medigap premiums Effectively capped Separate Part D plan required
    Medicare Advantage (avg in Vermont) Varies by plan Capped (varies) Usually included

    Medicare Advantage Coverage for Hip Replacement in Vermont

    Medicare Advantage plans in Vermont must cover all services that Original Medicare covers for hip replacement, but may have different cost-sharing structures. With 6 MA plans available in Vermont, you can compare plans specifically for their hip replacement coverage, including specialist networks, prior authorization requirements, and drug formularies. The average MA plan in Vermont is rated 4.0 stars by CMS.

    Medicare Part D Coverage for Hip Replacement Medications in Vermont

    Most medications for hip replacement are covered under Medicare Part D in Vermont. Check individual plan formularies at medicare.gov/plan-compare for specific drug coverage and tier placement.

    Medicaid and Hip Replacement in Vermont

    Vermont 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 Vermont with hip replacement, Medicaid covers Medicare cost-sharing (premiums, deductibles, and copays), providing comprehensive coverage with minimal out-of-pocket costs.

  • Medicare Coverage for Hip Replacement in Utah 2026: What’s Covered & Costs

    Medicare Coverage for Hip Replacement in Utah

    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 Utah 480,000

    Does Medicare Cover Hip Replacement in Utah?

    Yes — Medicare covers hip replacement treatment in Utah 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 Utah

    • 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 Utah

    Under Original Medicare in Utah, 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 Utah 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 Utah

    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 + $1,416 Medigap premiums Effectively capped Separate Part D plan required
    Medicare Advantage (avg in Utah) Varies by plan Capped (varies) Usually included

    Medicare Advantage Coverage for Hip Replacement in Utah

    Medicare Advantage plans in Utah must cover all services that Original Medicare covers for hip replacement, but may have different cost-sharing structures. With 22 MA plans available in Utah, you can compare plans specifically for their hip replacement coverage, including specialist networks, prior authorization requirements, and drug formularies. The average MA plan in Utah is rated 3.9 stars by CMS.

    Medicare Part D Coverage for Hip Replacement Medications in Utah

    Most medications for hip replacement are covered under Medicare Part D in Utah. Check individual plan formularies at medicare.gov/plan-compare for specific drug coverage and tier placement.

    Medicaid and Hip Replacement in Utah

    Utah 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 Utah with hip replacement, Medicaid covers Medicare cost-sharing (premiums, deductibles, and copays), providing comprehensive coverage with minimal out-of-pocket costs.

  • Medicare Coverage for Hip Replacement in Texas 2026: What’s Covered & Costs

    Medicare Coverage for Hip Replacement in Texas

    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 Texas 4,680,000

    Does Medicare Cover Hip Replacement in Texas?

    Yes — Medicare covers hip replacement treatment in Texas 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 Texas

    • 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 Texas

    Under Original Medicare in Texas, 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 Texas 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 Texas

    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 Texas) Varies by plan Capped (varies) Usually included

    Medicare Advantage Coverage for Hip Replacement in Texas

    Medicare Advantage plans in Texas must cover all services that Original Medicare covers for hip replacement, but may have different cost-sharing structures. With 118 MA plans available in Texas, you can compare plans specifically for their hip replacement coverage, including specialist networks, prior authorization requirements, and drug formularies. The average MA plan in Texas is rated 3.8 stars by CMS.

    Medicare Part D Coverage for Hip Replacement Medications in Texas

    Most medications for hip replacement are covered under Medicare Part D in Texas. Check individual plan formularies at medicare.gov/plan-compare for specific drug coverage and tier placement.

    Medicaid and Hip Replacement in Texas

    Texas has not expanded Medicaid, meaning most adults without dependent children do not qualify for Medicaid regardless of income. Only parents earning up to 15% FPL ($4,098/year for a family of three) may qualify. For dual-eligible individuals in Texas with hip replacement, Medicaid covers Medicare cost-sharing (premiums, deductibles, and copays), providing comprehensive coverage with minimal out-of-pocket costs.

  • Medicare Coverage for Hip Replacement in Tennessee 2026: What’s Covered & Costs

    Medicare Coverage for Hip Replacement in Tennessee

    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 Tennessee 1,440,000

    Does Medicare Cover Hip Replacement in Tennessee?

    Yes — Medicare covers hip replacement treatment in Tennessee 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 Tennessee

    • 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 Tennessee

    Under Original Medicare in Tennessee, 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 Tennessee 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 Tennessee

    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 + $1,416 Medigap premiums Effectively capped Separate Part D plan required
    Medicare Advantage (avg in Tennessee) Varies by plan Capped (varies) Usually included

    Medicare Advantage Coverage for Hip Replacement in Tennessee

    Medicare Advantage plans in Tennessee must cover all services that Original Medicare covers for hip replacement, but may have different cost-sharing structures. With 44 MA plans available in Tennessee, you can compare plans specifically for their hip replacement coverage, including specialist networks, prior authorization requirements, and drug formularies. The average MA plan in Tennessee is rated 3.8 stars by CMS.

    Medicare Part D Coverage for Hip Replacement Medications in Tennessee

    Most medications for hip replacement are covered under Medicare Part D in Tennessee. Check individual plan formularies at medicare.gov/plan-compare for specific drug coverage and tier placement.

    Medicaid and Hip Replacement in Tennessee

    Tennessee has not expanded Medicaid, meaning most adults without dependent children do not qualify for Medicaid regardless of income. Only parents earning up to 105% FPL ($28,686/year for a family of three) may qualify. For dual-eligible individuals in Tennessee with hip replacement, Medicaid covers Medicare cost-sharing (premiums, deductibles, and copays), providing comprehensive coverage with minimal out-of-pocket costs.

  • Medicare Coverage for Hip Replacement in South Dakota 2026: What’s Covered & Costs

    Medicare Coverage for Hip Replacement in South Dakota

    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 South Dakota 200,000

    Does Medicare Cover Hip Replacement in South Dakota?

    Yes — Medicare covers hip replacement treatment in South Dakota 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 South Dakota

    • 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 South Dakota

    Under Original Medicare in South Dakota, 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 South Dakota 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 South Dakota

    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 + $1,344 Medigap premiums Effectively capped Separate Part D plan required
    Medicare Advantage (avg in South Dakota) Varies by plan Capped (varies) Usually included

    Medicare Advantage Coverage for Hip Replacement in South Dakota

    Medicare Advantage plans in South Dakota must cover all services that Original Medicare covers for hip replacement, but may have different cost-sharing structures. With 10 MA plans available in South Dakota, you can compare plans specifically for their hip replacement coverage, including specialist networks, prior authorization requirements, and drug formularies. The average MA plan in South Dakota is rated 3.7 stars by CMS.

    Medicare Part D Coverage for Hip Replacement Medications in South Dakota

    Most medications for hip replacement are covered under Medicare Part D in South Dakota. Check individual plan formularies at medicare.gov/plan-compare for specific drug coverage and tier placement.

    Medicaid and Hip Replacement in South Dakota

    South Dakota 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 South Dakota with hip replacement, Medicaid covers Medicare cost-sharing (premiums, deductibles, and copays), providing comprehensive coverage with minimal out-of-pocket costs.

  • Medicare Coverage for Hip Replacement in South Carolina 2026: What’s Covered & Costs

    Medicare Coverage for Hip Replacement in South 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 South Carolina 1,120,000

    Does Medicare Cover Hip Replacement in South Carolina?

    Yes — Medicare covers hip replacement treatment in South 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 South 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 South Carolina

    Under Original Medicare in South 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 South 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 South 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 + $1,416 Medigap premiums Effectively capped Separate Part D plan required
    Medicare Advantage (avg in South Carolina) Varies by plan Capped (varies) Usually included

    Medicare Advantage Coverage for Hip Replacement in South Carolina

    Medicare Advantage plans in South Carolina must cover all services that Original Medicare covers for hip replacement, but may have different cost-sharing structures. With 36 MA plans available in South 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 South Carolina is rated 3.8 stars by CMS.

    Medicare Part D Coverage for Hip Replacement Medications in South Carolina

    Most medications for hip replacement are covered under Medicare Part D in South Carolina. Check individual plan formularies at medicare.gov/plan-compare for specific drug coverage and tier placement.

    Medicaid and Hip Replacement in South Carolina

    South Carolina has not expanded Medicaid, meaning most adults without dependent children do not qualify for Medicaid regardless of income. Only parents earning up to 67% FPL ($18,304/year for a family of three) may qualify. For dual-eligible individuals in South Carolina with hip replacement, Medicaid covers Medicare cost-sharing (premiums, deductibles, and copays), providing comprehensive coverage with minimal out-of-pocket costs.

  • Medicare Coverage for Hip Replacement in Rhode Island 2026: What’s Covered & Costs

    Medicare Coverage for Hip Replacement in Rhode Island

    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 Rhode Island 260,000

    Does Medicare Cover Hip Replacement in Rhode Island?

    Yes — Medicare covers hip replacement treatment in Rhode Island 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 Rhode Island

    • 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 Rhode Island

    Under Original Medicare in Rhode Island, 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 Rhode Island 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 Rhode Island

    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 + $2,016 Medigap premiums Effectively capped Separate Part D plan required
    Medicare Advantage (avg in Rhode Island) Varies by plan Capped (varies) Usually included

    Medicare Advantage Coverage for Hip Replacement in Rhode Island

    Medicare Advantage plans in Rhode Island must cover all services that Original Medicare covers for hip replacement, but may have different cost-sharing structures. With 12 MA plans available in Rhode Island, you can compare plans specifically for their hip replacement coverage, including specialist networks, prior authorization requirements, and drug formularies. The average MA plan in Rhode Island is rated 4.1 stars by CMS.

    Medicare Part D Coverage for Hip Replacement Medications in Rhode Island

    Most medications for hip replacement are covered under Medicare Part D in Rhode Island. Check individual plan formularies at medicare.gov/plan-compare for specific drug coverage and tier placement.

    Medicaid and Hip Replacement in Rhode Island

    Rhode Island 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 Rhode Island with hip replacement, Medicaid covers Medicare cost-sharing (premiums, deductibles, and copays), providing comprehensive coverage with minimal out-of-pocket costs.

  • Medicare Coverage for Hip Replacement in Pennsylvania 2026: What’s Covered & Costs

    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.