Medicare Coverage for Hip Replacement in District of Columbia
| 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 District of Columbia | 98,000 |
Does Medicare Cover Hip Replacement in District of Columbia?
Yes — Medicare covers hip replacement treatment in District of Columbia 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 District of Columbia
- 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 District of Columbia
Under Original Medicare in District of Columbia, 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 District of Columbia 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 District of Columbia
| 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 + $2,376 Medigap premiums | Effectively capped | Separate Part D plan required |
| Medicare Advantage (avg in District of Columbia) | Varies by plan | Capped (varies) | Usually included |
Medicare Advantage Coverage for Hip Replacement in District of Columbia
Medicare Advantage plans in District of Columbia must cover all services that Original Medicare covers for hip replacement, but may have different cost-sharing structures. With 8 MA plans available in District of Columbia, you can compare plans specifically for their hip replacement coverage, including specialist networks, prior authorization requirements, and drug formularies. The average MA plan in District of Columbia is rated 4.2 stars by CMS.
Medicare Part D Coverage for Hip Replacement Medications in District of Columbia
Most medications for hip replacement are covered under Medicare Part D in District of Columbia. Check individual plan formularies at medicare.gov/plan-compare for specific drug coverage and tier placement.
Medicaid and Hip Replacement in District of Columbia
District of Columbia 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 District of Columbia 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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