The cost of a hip replacement with insurance can vary depending on several factors, including the type of insurance you have, the specific details of your policy, the hospital or healthcare facility where you receive treatment, and the particular surgeon performing the procedure. Generally, with insurance coverage, a hip replacement can cost several thousand dollars, but the out-of-pocket expenses for the patient will depend on the specific policy.
Most insurance policies cover a portion of the cost of a hip replacement, typically ranging from 70-90% of the total cost. However, the remaining 10-30% of the cost will be the responsibility of the patient. Some insurance policies may also have a deductible or co-payment that the patient must pay before the insurance coverage kicks in.
The specific cost of a hip replacement procedure can vary widely depending on factors such as the geographic location, the hospital or medical center chosen, and the specific surgeon chosen to perform the procedure. According to a report by Blue Cross Blue Shield, the average cost of a hip replacement in the United States in 2020 was $33,734. However, this cost can be significantly higher or lower depending on the location, the hospital or facility, and other factors.
It’s also important to note that some insurance plans may have limits on how much they will cover for certain procedures. For example, some insurance policies may have a maximum dollar amount that they will pay for a hip replacement procedure, which could result in higher out-of-pocket expenses for the patient. It’s important to review your insurance policy carefully to understand any limitations or restrictions on coverage for hip replacements or other procedures.
In addition to the cost of the procedure itself, there may be additional costs associated with a hip replacement, such as pre-operative testing, anesthesia, post-operative care, and physical therapy. These costs can add up quickly and may also be partially covered by insurance.
If you are considering a hip replacement procedure, it’s important to talk to your insurance provider to understand your coverage and any out-of-pocket expenses that you may be responsible for. It’s also a good idea to research the cost of the procedure at different hospitals or healthcare facilities to find the most affordable option that meets your needs. Additionally, it’s important to choose a qualified and experienced surgeon who can perform the procedure safely and effectively.
The majority of the 330,000 Americans who have their hips replaced each year will receive entirely different medical bills. Why? Because the location of your medical care, the physician you choose, your insurance, and the specifics of your procedure all affect how much it will cost you. For instance, the cost of the anesthesiologist increases with the length of your surgery. Even inside the same network, companies can charge wildly different amounts for the same services.
How are you expected to determine what you should pay with this information? Healthcare Bluebook, which determines the “Fair Price” for medical procedures and services based on the actual amounts health insurance actually pay in claims, is the solution.
The Average Price of a Hip Replacement
Healthcare Bluebook estimates that the cost of hip replacement surgery can range from $23,203 to more than $74,000. I have personal experience with a woman whose hip replacement surgery cost her $102,000, so the range is substantial.
The fair cost of hip replacement surgery is estimated by Healthcare Bluebook to be $25,779. The breakdown of that cost is as follows:
- Healthcare Services
- Cost of an implant: $8,000 (Check with your provider to see which implant they plan to use as that can affect cost.)
- Admission for 3 Days: $5,400 (about $1,800 each day).
- Additional medical expenses: $8,515 (These can vary.)
- $21,915 in total for medical services
- $2,679 (For the procedure and common post-operative treatment.)
- Anesthesia
- $1,185 (Price based on a 2.5-hour surgery on average. Surgery time will determine the final cost.)
- Combined amount: $25,779
Remember that these fees only represent a reasonable estimation of the cost of the actual procedure; they do not cover physical therapy or any medications you might require prior to or following the procedure.
How Much Will You Expense Actually?
Your insurance will determine how much you will have to pay out of pocket for hip replacement surgery. Do you recall the woman whose surgery cost $102,000? Since she had already met her deductible and had excellent health insurance, she only had to pay $520 for that.
You will be liable for the full cost if you don’t have health insurance. It will depend on your deductible, coinsurance, and maximum out-of-pocket expense if you have health insurance.
Healthcare.gov states that typical healthcare coverage looks like this:
- Taxable: $1,300
- Co-insurance: Maximum Out-of-Pocket: 20% Cost: $4,400
- You would be responsible for $4,400 of the cost if this was your plan and your hip replacement was the first medical operation you underwent in that year. If your deductible had already been met, you would be liable for 20% of the cost up to $3,100 ($4,400 in total out-of-pocket expenses minus the $1,300 deductible you had previously paid).
To get an idea of how much your hip replacement surgery will likely cost, ask your provider for an estimated cost. Ask about the sort of implant they want to use, the anticipated time required for the procedure, and the anticipated length of your hospital stay. Then, compare prices to ensure that you’re receiving the greatest care for the lowest cost.
Get the following details from your insurance carrier once you’ve decided on your provider and have their estimate:
- remaining balance of your deductible.
- You are responsible for coinsurance.
- Maximum out-of-pocket expense.
Once you know that information, you may estimate how much your own hip replacement operation will probably cost. Although it may seem like a lot of work up front, doing a little research and comparison shopping might be the difference between paying $500 for your operation and hundreds (or tens of thousands) of dollars.
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Insurance Coverage
Generally speaking, Medicaid and Medicare, as well as the majority of health insurance policies, cover hip replacement surgery. Your surgeon and his staff will help prove that the procedure is a medical necessity for you in order for your surgery to be covered by your insurance plan. The best way to learn more about your policy is to chat with your insurer.
You should confirm that your insurance doesn’t solely cover certain kinds of hip implants. If you need pre-authorization or any other documents, ask your insurer.
Expenses Covered under Insurance
The following expenses for hip replacement surgery are commonly covered by health insurance policies:
- Schedule a consultation with an orthopedic surgeon
- additional consultations before surgery
- laboratory testing and other diagnostic tests
- Charges associated with surgery, including those related to the surgeon’s fee, anesthesia, operating room costs, and hip implants
- a stay in a hospital after surgery
- Preparing your home for post-operative rehabilitation, including getting any necessary medical equipment and safety bars
- appointments for rehabilitation and physical therapy
- To get a clear understanding of how much of the cost will be paid, it is crucial to understand any limits on your insurance coverage.
Out-of-Pocket Expenses
Your insurance policy’s provisions will determine your out-of-pocket expenses for your hip replacement operation. Even if your insurance covers hip replacement, you can still be responsible for some of the expenses.
Speak with your insurance provider about the expenses you will incur for your surgery, such as deductibles, co-pays, and co-insurance. You might be able to save a lot of money with supplement insurance. Additionally, you might be qualified to deduct any out-of-pocket expenses from the funds in your health savings account (HAS), flexible spending account (FSA), and health reimbursement account (HRA).
Costs without Insurance Coverage
You should talk about the charges with your orthopedic surgeon during the initial visit if your health plan does not cover hip replacement surgery or if you do not have insurance coverage. The price of a hip replacement might vary from practice to practice and even from patient to patient based on a number of variables.
The operating surgeon’s training and expertise, the facilities and services they can offer, and the caliber of the hospital or surgery center where the treatment is carried out will all have an impact on final prices. Make sure you don’t choose an orthopedic surgeon based solely on price while making your selection.
Be sure to carefully assess the surgeon’s training, experience, and orthopedic surgery board certification. Your ultimate outcomes will be significantly affected by these factors. For hip replacement surgery, Dr. Thomas and Dr. Bigler, board-certified orthopedic surgeons, see patients from Las Vegas, Nevada as well as the surrounding areas of Pahrump, Bullhead City, Lake Havasu, and Mesquite.
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