Knee replacement surgery is a major medical undertaking, and that means there will likely be significant expenses related to your operation and recovery. The good news is that health insurance plans are put in place for this very reason, to help offset the majority of your medical expenses in the event that you need a procedure. But that doesn’t mean every procedure and treatment is fully covered by your health insurance. Below, we explore some of the insurance aspects you’ll want to consider before knee replacement surgery so that there are no surprise medical expenses in your future.
Is Knee Replacement Covered By Health Insurance?
We’ll start with the good news – most health insurance plans, including Medicare and Medicaid, cover knee replacement surgery. They may not cover every single expense related to your knee replacement operation, but in general, health insurance and Medicare/Medicaid will cover:
- An evaluation with an orthopedic surgeon.
- Pre-operative appointments and diagnostic testing.
- The surgery itself, including fees for the doctor, anesthesia, the implant and the operating room.
- Postoperative hospitalization costs.
- Assistive medical devices (crutches, cane, etc.) or in-home assistive devices (handrails, safety bars, etc.)
- Postoperative physical therapy and rehabilitation services.
However, in order for your health insurance provider to cover part or all of these costs, the services must be proven to be a medical necessity. Oftentimes all that is needed to reach this threshold is a recommendation from an orthopedic surgeon, but your doctor may require that you attempt at least 6-8 weeks of physical therapy and other non-operative techniques before they recommend surgery.
You’ll also want to try to understand your out-of-pocket costs. Your health insurance plan will likely cover the majority of your expenses, but you’ll likely need to pay part of the cost as well. It’s in your best interest to contact your insurance provider and ask about your projected costs for things like co-pays, deductibles and your maximum out of pocket costs. This will help prevent any surprise bills down the road.
Also, know that you’re able to apply your FSA or HSA money towards your medical expenses. A Flex Savings Account or Health Savings Account allows you to put pre-taxed earnings towards certain expenses, which can save you around 20-35% or more depending on your income and tax rate. If you know that knee replacement is in your future, consider choosing a health insurance plan that offers one of these accounts and contribute to it regularly to help put pre-taxed earnings towards your surgery.
Finally, it’s also worth ensuring ahead of time that you’ve met any specific waiting period outlined by your health insurance plan. Some health insurers require a person to have a plan for at least a certain amount of time before they’ll pay for a major operation, because after all, they don’t just want someone to pick a great health insurance plan at the start of the year just so they can have a major surgery performed as soon as they are enrolled. If you believe a joint replacement operation may be in your future, really look closely at the waiting periods that come with any new health insurance plan you’re considering. Don’t swap into a new plan only to find out you’ll need to wait many months before your surgery will be approved.
If you can do all of these things, we’re confident you can avoid an unwanted expense following your knee replacement surgery and recovery. And if you have any questions or concerns about the financial side of knee replacement surgery, reach out to Dr. Botero or your insurance provider.
