Understanding Knee Replacement Costs


Knee Replacement Costs


Cost is an essential point to consider when you’re thinking about total knee replacement surgery. For many people, their insurance will cover the cost, but there may be additional expenses.

Here, you can find out more about the cost of knee replacement surgery.

The cost of a knee replacement can vary widely, depending on where you live, which clinic you use, your overall health, and other factors.

What contributes to the cost?

The final hospital bill will depend on many factors, including:

  • Number of days you spend in the hospital. This will depend on whether your knee replacement is total, partial, or bilateral.
  • Type of implant and surgical approach. This includes the material the implant is made of and the use of any customized surgical instruments or specialized computer technology.
  • Preexisting conditions. You might need extra care in the hospital or additional precautions during surgery.
  • Time spent in the operating room. If the damage is complex, it can take longer to operate, and this will be more costly.
  • Unanticipated care or equipment. If complications occur, you may need additional care.

Multiple bills

There will usually be multiple bills after a knee replacement surgery, including those for:

  • hospital care
  • all treatments from the surgeon while in the hospital
  • other tasks and procedures performed by the operating room staff

Other tasks and costs include work done by the anesthesiologist, surgical assistants, physical therapists, and others.

Average costs

According to a 2013 article in AARP, U.S. hospitals charge $50,000, on average, for a total knee replacement (TKR). A partial knee replacement (PKR) typically costs about 10 to 20 percent less than a TKR. Your health insurance and Medicare will cover most of the cost, but there will still be payments to make.

More recently, Blue Cross Blue Shield estimated in 2019 that the average cost of an inpatient knee replacement procedure was $30,249, compared with $19,002 as an outpatient.

The main reason is that a PKR needs a shorter hospital stay: an average of 2.3 days, compared with 3.4 days for a TKR.

Keep in mind that hospital charges don’t reflect the amount you pay out of pocket. You can learn more about out-of-pocket costs below.

Inpatient charges are those that occur while you’re in the hospital.

Charges from the surgeon and other healthcare providers may add an average of roughly $7,500 to the basic hospital charge for the procedure, but this will depend on the clinic and other factors.

Discounts

Hospitals will sometimes provide discounts if you don’t have health insurance or aren’t covered by Medicare. Ask about a possible discount or payment plan before scheduling your surgery if you don’t have insurance coverage. You should try to estimate your costs in advance whether or not you have insurance.

Medicare

Once you’ve reached your deductible, Medicare typically pays 100 percent of inpatient charges related to a procedure and the hospital stay. Private insurance plans pre-negotiate fees with hospitals and providers. They usually only pay a percentage of the total charges.

Private insurance

Private insurance varies, and it’s important to review your benefits plan before scheduling a knee replacement.

Check the following points before making your decision:

  • your deductible
  • which providers are in your insurance network
  • which services your insurance covers

Ask your doctor

Before arranging for surgery, speak with your doctor, a hospital representative, and your insurance provider to find out what the average charges are for your area and what discounts may apply.

Inpatient procedures and hospital charges will be your biggest expenses.

But you’ll also need to pay for outpatient services before and after your procedure. Outpatient refers to services that occur when you’re not in the hospital.

These additional expenses include:

  • pre- and postoperative costs from office visits and lab work
  • physical therapy
  • follow-up visits with your surgeon during your recovery

Medicare typically pays 80 percent of the outpatient service charges for its members. Private insurance plans vary.

You should expect deductibles and copays to apply to any outpatient or office visit charges before and after your surgery.

Bills vary, but here’s what you generally can expect if you have a knee replacement:

Presurgical preparation

The presurgical evaluation phase consists of a consultation or office visit, imaging, and lab work. The lab work usually includes blood work, cultures, and panel tests.

The number of expected services and total charges varies by insurance coverage and age group.

For example, someone over the age of 65, usually covered by Medicare, generally requires more lab work than someone under 65. This is because an older adult is more likely to have preexisting conditions that must be understood fully during a presurgical evaluation.

Hospital stay and surgery

You’ll receive separate bills for a TKR. As discussed above, the hospital will bill you for your stay, time spent in the operating room, and other applicable hospital services, supplies, and equipment used.

Providers will bill you for procedure charges that cover services provided by the surgeon, as well as:

  • anesthesia
  • injections
  • pathology services
  • surgical assistance, for example, operation of computer-aided or other technology
  • physical therapy
  • coordination of care

Keep in mind that many other factors can affect charges and costs related to a procedure.

Complications can affect anyone, but people with preexisting conditions may be more susceptible. If complications occur, you may need additional care, and this will add to your bill.

Diabetes, obesity, and anemia are all examples of preexisting conditions.

Postsurgical care

Recovery and rehabilitation include:

  • outpatient physical therapy services
  • any tools and treatments the physical therapist uses
  • outpatient follow-up

Totals

The average out-of-pocket expense in the United States ranges widely. It’ll depend on your insurance plan.

For Medicare patients, out-of-pocket costs may be in the hundreds of dollars. Those with private insurance can expect these costs to reach into the thousands.

Review your plan carefully if you have private insurance. Remember to factor in your deductible, copay, coinsurance, and max out-of-pocket values.

The cost of care and services is only part of the overall expense.

Equipment

There may be extra payments for special equipment, known as durable medical equipment, such as a continuous passive motion machine, walker, or crutches.

Home care services

Most insurance plans and Medicare cover these devices. However, they may appear as additional charges on your hospital bill or another bill.

You may also need additional physical therapy or a nurse in your home.

Expect to pay out of pocket if your insurance doesn’t cover home care services.

There will be additional costs if you’re unable to return home immediately and need to spend time in a rehab or nursing facility for extra care.

Home modifications

You may need to install safety equipment in your home, such as:

  • safety bars and rails
  • a shower bench
  • a toilet seat riser with arms

Remember to factor in lost income if you take time off from work for the surgery or during recovery. Talk to your employer and insurance provider to find out if you qualify for any disability insurance options that cover time off work.

Disability insurance is a type of insurance that pays out a partial wage to employees who can’t work because of an injury or disability. It may cover time off that you need for surgeries such as TKRs.

Some people opt for surgery overseas. The cost may be significantly lower in countries like Mexico, India, or Taiwan. However, you may spend several thousand dollars on airline tickets, hotels, and related expenses.

If you’re considering taking this route, make sure that the facility has international accreditation by the Joint Commission International before agreeing to the procedure.

If it does, this means the surgeons are accredited and that the facilities and prostheses meet the highest standards.

By knowing the costs upfront, you can avoid surprises — and possible hardships — down the line.

Where are these charges coming from?

The bill for a total knee replacement has both pre- and postsurgery cost, as well as the price of the surgery itself, with charges including:

  • presurgery doctor visits and lab work
  • the surgery and the time you spend in the operating room, including charges for the anesthesia and other tools used
  • your hospital stay
  • postsurgery doctor visits
  • physical therapy

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