Medicare Knee Replacement Age Limit

There is no specific age limit for knee replacement surgery.

Still, it is essential to remember that Original Medicare coverage will only be granted if the procedure is medically necessary. Discussing the need for surgery with your doctor to determine eligibility and enrollment to avoid unnecessary costs is always wise.

What Is Knee Replacement?

A knee replacement surgery is a medical procedure in which a diseased or damaged knee joint is replaced with an artificial joint made of metal, plastic, or ceramics. Knee replacements are often recommended for people with chronic knee pain, arthritis, or other mobility issues.

The surgery is usually done under general anesthesia and takes approximately one to two hours. Most people spend a few days inpatient after the surgery and require physical therapy to regain full mobility.

What Medicare Benefits Are Available For Knee Surgery?

Medicare Part A and Part B cover knee replacement surgery for eligible individuals aged 65 and older. Medicare will cover the costs of the hospital stay, doctor’s fee, and any related medical devices such as walkers, wheelchairs, or crutches.

Some patients may require more extensive rehabilitation services after the surgery, such as physical therapy or occupational therapy, which can be covered by Medicare Part B.

In addition to covering the cost of the surgery and associated medical expenses, Medicare also covers a portion of the cost for certain medications necessary after knee replacement surgery, such as anti-inflammatories or painkillers.

What Should Seniors Consider Before Having Knee Replacement Surgery?

As with any surgery, knee replacement surgery should be considered carefully before proceeding. Seniors should consider their overall quality of life, the amount of pain they are experiencing, their current level of mobility, and the knee replacement costs.

In addition, seniors should discuss their surgical procedure options with their doctor.

There are several types of knee replacement surgeries, including robotic knee replacement surgery, each with risks and benefits, which should be considered during the evaluation process.

Bottom Line

In summary, choosing to have a knee replacement surgery can be a life-changing event for seniors experiencing chronic pain or mobility issues. Medicare recognizes the need for this procedure and offers coverage for Medicare beneficiaries under Parts A and B.

The Medicare knee replacement age limit is not a specific age but is determined by the medical necessity of the surgery. Before making any surgical decision, seniors should consider their overall health status, level of pain, current mobility, and surgical options.

By working closely with their doctor, seniors can make informed decisions about their health insurance needs and receive Medicare coverage.

Sources: Humana – AARP.org – EvaluateSurgicalUtah

FAQ's

• What is the oldest age for knee replacement surgery?

  There is no specific age limit for knee replacement surgery, but it must be considered medically necessary to be covered by Medicare. Generally, the oldest recommended age for a knee replacement is 85-90 years old as long as the patient is healthy and the procedure can be performed safely.

• What is the Medicare-approved amount for knee replacement surgery?

  The amount of coverage for knee replacement surgery will depend on the individual’s circumstances. Generally, Medicare covers 80% of approved costs up to a specific limit set by Medicare. The patient is responsible for the out-of-pocket costs of 20%, including co-pays or coinsurance amounts and any applicable deductibles.