The cost of knee replacement surgery: 5 key factors

Making the decision to get a knee replacement is a big one.

For starters, you need to make sure it’s the best treatment option for you and your knee pain, and that you’re timing your knee replacement surgery just right. But you also need to consider nonsurgical alternatives to knee surgery, potential risks for knee replacement surgery, who will help you while you rehab and heal, and so much more. And one of your biggest considerations may be how much your knee replacement will cost.

Studies show that total average cost for a knee replacement in the United States is somewhere between $15,000 and $75,000. But it can be confusing to figure out what that price tag includes.

In many cases, some insurers – like HealthPartners – can bundle costs for your surgery and post-op rehab. But you’ll likely have some out-of-pocket costs for care leading up to and after your surgery, even if you’ve met your deductible for the year.

So, if you want to know how much a knee replacement will cost, there are five key factors to be aware of.

Five key factors that affect the cost of knee replacement surgery

1. The type of knee replacement you need

There are three types of knee surgeries, each with varying levels of complexity and equipment needs:

Partial knee replacement
Total knee replacement
Revision (or complex) knee replacement

Costs will vary depending on whether you have traditional knee surgery or robotic knee replacement surgery. Your orthopedic surgeon will work with you to determine which type of knee replacement will work best for you. At TRIA, our orthopedic surgeons will coach you through the process and make recommendations based on many factors, including your age, knee health, bone structure, range of motion, lifestyle, goals and the possibility of needing a revision surgery in the future.

While it may seem like a full knee replacement surgery would be the costliest, a revision surgery is actually the most expensive. Total cost of any surgery will depend on the complexity of the surgery, among other factors, but a partial knee replacement typically costs anywhere from 10% to 50% less than a total knee replacement.

2. Your knee replacement surgery ‘classification’

There are two types of knee replacement surgery classifications: inpatient surgeries and outpatient surgeries.

Oftentimes, “inpatient” means you’ll have a hospital stay after surgery, and “outpatient” means you’ll be discharged the same day as your surgery. But that may not be how your insurance company classifies your surgery.

In fact, it’s very possible that a knee replacement surgery would be classified as an outpatient surgery. Many patients do go home the same day as their surgery if they meet certain criteria and their insurance covers it. But even if a patient spends a night in the hospital, it’s likely that their surgery will be considered outpatient. This can have an impact on the total amount you’re responsible for.

3. Where you get your knee replacement surgery

Knee replacement surgeries can be done at both hospitals and surgery centers.

A surgery center is a location that focuses on same-day surgeries and may or may not be attached to a hospital. Sometimes, surgery centers – like TRIA’s state-of-the-art outpatient surgery center – specialize in specific procedures. But in order to have your procedure at a surgery center, you need to meet the medical criteria. This usually means you’re not a high-risk patient.

If you have your procedure at a hospital, the fees for the operating room can have a big impact on the final cost. In some cases, costs can be impacted by how long you need to stay in the hospital. But as we mentioned earlier, this is usually determined by how your surgery is classified.

All that said, usually it’s less expensive – for you and your insurance company – if you have your procedure at a surgery center.

4. Your recovery plan

Where you go to recover immediately after your surgery can affect total costs.

If you have your surgery at a hospital, chances are that your insurance company has already built one or more overnight stays into a fixed-rate payment. This means that regardless of how long you stay (if at all), the insurance company pays the hospital one amount. This also means you don’t have to worry about incurring extra costs if you need to stay a day or two in the hospital if your doctors suggest doing so.

But as we mentioned earlier, if you have your surgery at a surgery center, you’ll be discharged that same day. That means you’ll head home to begin your recovery unless you opt for transitional care.

Most surgery centers have some type of overnight stay option – some of which are more homey and unique, like TRIA’s Hotel Recovery Program.

Through our recovery program, instead of staying overnight at the hospital or going home right away, you can go from the surgery center to a nearby hotel. At the hotel, you’ll stay with a friend or family member, and be surrounded by an experienced nursing and rehab staff 24/7.

In addition, whether you go home to recover or stay somewhere for a couple days, physical therapy and rehab will be a big part of your knee replacement recovery process.

Physical therapy uses exercises and stretches to improve your knee function and mobility. How often you see your physical therapist, and how long you need physical therapy, are cost factors.

5. Your health insurance coverage

Your health insurance coverage will play a big role in how much you pay for your knee replacement. So, we highly recommend taking time to understand your insurance coverage before beginning the knee replacement process.

To start, your knee replacement will need to be “ordered” by a doctor to be covered by insurance. This order lets your insurance company know a knee replacement surgery is necessary to help reduce or manage your knee pain and loss of function.

Your share of costs for these kinds of covered services will depend on your specific health insurance plan and whether it has copays, deductibles or coinsurance. Costs may also vary depending on what other care costs you’ve already had to pay during the plan year.

Most insurance brands, including HealthPartners, cover knee replacements. Medicare and Medicaid also cover knee replacements. Usually, most insurances will cover all or a significant portion of the following:

An initial appointment and evaluation with your orthopedic surgeon
Appointments you need before surgery, including appropriate testing and diagnostic exams
The knee replacement surgery, which includes the implant itself, anesthesia and fees for the doctor and operating room
The care you receive while you’re recovering immediately after your surgery
Physical therapy appointments you might need to help you recover
Some medical equipment, like safety bars, that will help prepare your home for your recovery

Of course, if you have questions about your coverage, call the phone number on the back of your membership card.

How Medicare covers knee replacement costs

Medicare does cover knee replacements. But different parts of Medicare may pay for it, depending on the procedure you have, and the cost related to your knee replacement.

If it’s an inpatient surgery, Medicare Part A covers knee replacement costs. Part A may also pay for a brief stay in a skilled nursing facility after your knee replacement, if recommended by your doctor and you’ve had a qualifying hospital stay of at least three days prior to your admission.

If the procedure is an outpatient surgery, Medicare Part B may cover 80% of the charges after you meet your Part B deductible. And in most cases, Part B also covers 80% of the visits you may need before and after the procedure for evaluation, follow-up and physical therapy. If a cane or walker is ordered by your doctor for use during recovery, Part B should cover that too.

Having a Medicare Advantage plan or a stand-alone Medicare Part D Prescription Drug Plan can further reduce your out-of-pocket costs for knee replacement surgery. But benefits of these plans can vary quite a bit since they’re offered by different insurance companies. To understand how your supplemental plans may reduce your costs, it’s best to check with the plan provider.