Does Medicare cover it?
Does Medicare cover knee replacement surgery?
Yes, Medicare covers a medically necessary total knee replacement, either with a hospital admission under Part A or as a hospital outpatient under Part B. What you pay depends on that status more than on anything else. The estimator compares both with 2026 rates.
What this service costs you
You pay
$2,204
| Medicare-approved amount | $1,210 |
| Part A deductible | $1,736 |
| Part B deductible used | $283 |
| Your 20% or copayment | $185 |
| Medicare pays | $742 |
| Deductible left after this | $0 |
As an inpatient: the Part A deductible covers the hospital, plus 20% of the surgeon’s fee under Part B.
Same service at national rates: $2,194
How this is calculatedMedicare covers a total knee replacement when it is medically necessary, and the bill depends first on whether you are admitted as an inpatient or treated as a hospital outpatient. Admitted with a doctor's order to a hospital that accepts Medicare, Part A covers the hospital stay after the $1,736 Part A deductible for 2026, which pays for days 1 to 60 of the benefit period, and Part B covers the surgeon at 20% of the approved amount. At national rates the surgeon's fee is approved $1,159, so an inpatient knee replacement costs you about $1,968 once the Part B deductible is met: the Part A deductible plus $232 for the surgeon. As a hospital outpatient, the hospital's rate is approved $13,117, but your hospital copayment for a single service cannot exceed the Part A deductible, so your total lands at $1,968, close to the inpatient figure. If the Part A deductible was already paid in the same benefit period, an inpatient stay leaves only the surgeon's 20%. Medigap Plan G pays both the Part A deductible and the 20%, which brings the inpatient case to $0. The 2027 Part A and Part B amounts are not published yet.
Inpatient or outpatient knee replacement
Inpatient: you pay
$1,968
| Hospital outpatient | $1,968 |
| Difference | $0 |
Part B deductible met, national rates.
Costs computed by Radif Partners · Editorial policy · How the costs are calculated
Inpatient or outpatient: the question that sets the price
Medicare covers many medically necessary inpatient and outpatient surgeries, and a total knee replacement can be either. Inpatient means you are formally admitted to the hospital with a doctor's order saying you need inpatient care; staying overnight is not enough on its own. Outpatient means the hospital treats you without that admission; time under observation counts as outpatient, even overnight. Medicare's own advice before a surgery is to find out which one you are, because Part A pays for the first and Part B for the second.
| National rates, 2026 | Inpatient (Part A + Part B) | Hospital outpatient (Part B) |
|---|---|---|
| Surgeon, approved amount | $1,159 | $1,159 |
| Hospital | Part A, $1,736 deductible | $13,117 approved, copay capped |
| You pay, Part B deductible met | $1,968 | $1,968 |
| You pay, Part B deductible not met | $2,194 | $2,194 |
As an inpatient
For each benefit period in 2026, Part A charges a $1,736 deductible and then nothing for days 1 to 60, which covers a semi-private room, meals, general nursing, drugs given as part of the treatment and other hospital services and supplies. Part B then pays 80% of the approved amount for the doctors who treat you during the stay, which leaves the surgeon's 20% to you: $232 at national rates. A private room that is not medically necessary, a television or phone billed separately, private-duty nursing and personal care items are not covered.
The Part A deductible is due once per benefit period, not once a year. If you were already hospitalized recently and paid it in the same benefit period, the knee replacement costs you only the surgeon's share, $232.
As a hospital outpatient
When the operation is done without admission, Part B pays the hospital's outpatient rate, which for a total knee replacement is high: $13,117 nationally. Your hospital copayment on such a service would normally exceed the Part A deductible, but the CMS claims rules limit the copayment for one outpatient service to the inpatient deductible amount. You then add 20% of the surgeon's fee. That is why the two columns end up so close.
The surgeon's fee where you live
The surgeon is paid under the physician fee schedule, adjusted to local costs. The inpatient case leaves you $2,004 in Manhattan and $1,947 in Alabama, against $1,968 nationally, with the Part B deductible met. Other doctors who treat you during the stay also bill Part B; pick your area in the estimator to price the surgeon.
After the surgery
Recovery can bring two more kinds of bills. A skilled nursing facility stay after a qualifying inpatient stay of at least 3 days in a row is covered by Part A: $0 for the first 20 days, then $217 a day, so 30 days come to $2,170. Outpatient physical therapy afterwards is a Part B service at 20% with no yearly cap. A walker or a wheelchair for use at home falls under the durable medical equipment rules.
Medigap, Advantage and 2027
Medigap Plan G pays the Part A deductible and all Part B coinsurance, leaving only the Part B deductible if it is still due. Plan N does the same on these lines. With a Medicare Advantage plan, the plan may charge copayments during the first 60 days of a hospital stay instead of the Part A deductible; its documents give the figures. CMS has not yet published the 2027 Part A deductible or the 2027 Part B amounts, expected in mid-November, so a surgery planned for 2027 can only be priced with 2026 figures for now.