Does Medicare Cover Knee Replacement Surgery

Medicare Coverage of Total Knee Replacement:

The following are some facts which will help you understand if medicare covers total knee replacement (TKR).

1) Medicare covers TKR only when it is performed by a surgeon licensed by the state where the procedure is to be done.

2) There are no limits on what type of insurance plan may pay for TKR.

However, there are certain requirements that must be met before any payment can be made.

3) If you have private health insurance, your insurer may not pay for TKR.

You would need to purchase a policy with all or part of the cost covered by Medicare.

4) Medicare pays for most types of outpatient surgeries except those involving major blood vessels such as heart bypass operations and liver transplants.

The maximum amount paid for these procedures is $150,000 per patient.

5) Medicare pays for TKR only if the operation is medically necessary.

A physician must certify that the procedure is medically necessary.

6) Medicare will pay for TKR up to a limit of $250,000 per recipient.

If you receive more than $250,000 from Medicare, then your share will be 50 percent of the remaining amount above this dollar amount.

7) There is a three-day stay requirement before the procedure.

Do I Qualify For Medicare Part A Coverage?

Medicare Part A covers American citizens who have paid Medicare tax while working and are over the age of 65 or suffer from a qualifying disability. Turning 65 does not guarantee you will receive this coverage. You must apply for Medicare Part A by calling 1-800-772-1213 or visiting your local social security office in person. Once you are approved, you will receive a Medicare card in the mail.

Do I Qualify For Medicare Part B Coverage?

Medicare Part B is optional and may be purchased by paying monthly premiums. This part of medicare covers certain medical services and treatments that are considered non-medical such as:

1) Preventative services such as routine physicals, some screenings for cancer and diabetes, annual wellness checkups, immunizations, etc.

2) Outpatient care such as some surgeries (including TKR), emergency room visits, lab tests and diagnostic procedures.

3) Lab created prostheses such as heart valves, artificial hips, knees and other implants.

Furthermore, medicare will pay for all of the costs of your TKR if you receive both Part A and Part B coverage.

What Should I Look For In A TKR Center?

1) The surgeon should be board-certified in your state and have state license to perform the procedure you need.

2) The facility should be accredited by the Joint Commission (JCAHO).

This is a set of standards that all hospitals and surgery centers in the U.S. must meet in order to receive Medicare payments.

3) The surgeon should have performed at least 50 TKRs in the past year.

4) The surgeon should be friendly and able to answer your questions to your satisfaction.

5) The hospital or surgery center should perform more than 500 surgeries per year on an annual basis.

6) The facility should have a patient survival rate of at least 95 percent.

If you need a TKR and are covered by medicare, call (219) 923-4266 today to schedule your free consultation.

DID YOU KNOW?

Heart disease is the number one cause of death in the U.S. for both men and women. In fact, 1 out of every 4 deaths in America are caused by heart disease. Also, strokes have become the number three cause of death in the U.S.

These diseases are most commonly found in people over the age of 65. However, anyone can suffer from them due to bad eating habits, lack of exercise and/or family history. The good news is that they can be prevented with proper lifestyle choices and annual check-ups with your primary physician.

What Is A TKR?

A total knee replacement (TKR) is a surgical procedure used to treat patients suffering from severe arthritis and bone damage in one or both knees. During this procedure, your surgeon will remove damaged bone and cartilage from both knees and replace them with synthetic implants. The implants will serve as a cushion for your bones, while also promoting smoother movement of your knees.

How Does A TKR Compare To Other Knee Replacement Procedures?

There are three common types of knee replacement procedures: partial knee replacement, traditional knee replacement and a resurfacing procedure. Each one is slightly different and is used to treat patients suffering from different levels of arthritis and bone damage.

Partial Knee Replacements: Also known as a unicondylar knee replacement, this procedure involves removing only the damaged parts of your knee, while leaving the healthy parts intact. The most commonly replaced part is the top of your thigh bone or your shin bone.

Traditional Knee Replacements: Also known as a total knee replacement, this procedure involves removing both the damaged and healthy parts of your knee, while replacing them with synthetic implants. These implants will act as a cushion to protect your bones from further damage and help promote smoother movement.

Resurfacing Procedures: Unlike traditional and partial knee replacements, a resurfacing procedure does not replace the damaged parts of your knee with implants. Instead, it removes only the damaged portions of bone and cartilage, while reshaping the remaining bone and cartilage to provide a smoother surface.

What To Expect From A TKR

There are four main steps you will go through before, during and after a total knee replacement.

Step 1: Diagnosis and Consultation

The first step in the knee replacement process is seeing your family physician or specialist for a diagnosis and consultation. During this step, they will take your medical history and examine your knee to see if you qualify for the surgery. They will also explain the entire surgery process in detail and outline the benefits and risks of the procedure.

Step 2: Pre-Operation

Before your surgery, you will be given an opportunity to ask questions relating to the procedure and provide any information you believe is relevant to the surgeon. It is also important that you are fully prepared for anesthesia, which may include signing a consent form and having a nurse go over everything one last time with you.

During this step, your surgeon will also mark your knee to ensure they have a frame of reference when cutting the tissue. Finally, you will be instructed on how to properly position your knee for maximum healing benefits.

Step 3: Surgery

The actual knee replacement surgery typically lasts between 60 and 90 minutes. During this time, your surgeon will make an incision measuring between 6 and 10 inches long in your knee. Then, they will remove any damaged bone and cartilage, clean the exposed surface and insert the implants to promote smoother movement.

Next, your surgeon will attach the implant to your bone with screws and then use special instruments to shape and buff the implants for a smoother finish. Afterward, your surgeon will close your incision using surgical staples or sutures and apply a sterile bandage over the incision site. Finally, you will be taken to the recovery room for observation and slowly transitioned back to normal activity.

Step 4: Post-Operation

For the first few weeks following your knee replacement surgery, it is very important that you protect your incision site from breaking open or getting infected. To help prevent this from happening, your surgeon will provide you with a sterile bandage and gauze to put over your incision. You will also be given information on how to care for your incision at home.

During this time, you may have some moderate pain, but it should not be unbearable. For moderate pain, you can take over the counter pain medication. Be sure to follow the directions on the label and do not take more than the recommended dosage.

Your surgeon will also provide you with a prescription for stronger pain medication if needed.

You will also have information regarding physical therapy after your surgery. It is very important that you follow these guidelines as recommended, as physical therapy is crucial in order for your joint to heal properly.

After your incision has healed and you have completed your physical therapy, you surgeon will give you the okay to return to normal activity. You may still experience some pain and have minor aches and pains from time to time, but over-the-counter pain medication should suffice in relieving any discomfort. If not, speak to your physician about other pain management options.

Continue to work with your physician over the course of the next year to learn proper knee maintenance, as this will go a long way in helping your new knee last as long as possible.

Learn More About Arthritis of the Knee »

Total Knee Replacement Procedure Costs

If you don’t have health insurance, the total knee replacement procedure can be costly. Without health insurance, a total knee replacement can cost up to $11,000, and that’s if you’re a low-risk patient and qualify to get a discount from the hospital. If you’re not a low-risk patient or you don’t get a discount, the surgery price could be as high as $20,000 or more.

If you do have health insurance, the price of surgery will be lower. The average cost of a total knee replacement procedure in the U.S.

is $30,000, but this could vary widely depending on whether or not you’re categorized as a low-risk patient and what type of hospital and doctor you use.

The cost of a total knee replacement in the U.S. is four times greater than the cost in India, where the average price for this surgery is $7,000.

Cost of Knee Replacement Surgery in the U.S.

Hospital charges and surgeon’s fee : The cost of hospital charges for a total knee replacement in the U.S. averages around $20,270, with some hospitals charging as little as $15,000 and other hospitals charging upwards of $45,000.

The surgeon’s fee can range from $3,000 to $20,000 or more, depending on the hospital and the surgeon.

Anesthesia : Most total knee replacements in the U.S. are performed under a general anesthesia, which typically costs around $5,000.

Medical equipment used during surgery : Surgeons in the U.S. don’t usually provide or use their own medical equipment.

Instead, they most likely rent what they need from a medical supply company.

The cost of this equipment can range from $2,000 to $5,000 or more, and is typically washed and reused on multiple patients, so it doesn’t need to be replaced as often.

After your surgery, you may be able to get some of your medical equipment and supplies for free from a medical supply company or even your hospital if you don’t have insurance.

Anesthesia via Endoscopy: If you have a knee replacement using an anesthesia endoscopy (colloquially known as asleep surgery), the costs of anesthesia are much less, starting at roughly $2,500.

However, these types of procedures aren’t as common in the U.S. as a traditional general anesthetic for a knee replacement.

Sources & references used in this article:

Does Medicare save lives? by M Olmos – Medicare. Medicare. com. Accessed October, 2018

Clinical and cost outcomes of venous thromboembolism in Medicare patients undergoing total hip replacement or total knee replacement surgery by D Card, C Dobkin, N Maestas – The quarterly journal of …, 2009 – academic.oup.com

Disparities in major joint replacement surgery among adults with Medicare supplement insurance by O Baser, D Supina, N Sengupta, L Wang… – … medical research and …, 2011 – Taylor & Francis

Revision rates after knee replacement in the United States by K Hawkins, KH Escoto, RJ Ozminkowski… – Population health …, 2011 – liebertpub.com