Cost of Knee Replacement Surgery with and without Insurance

Knee replacement insurance

How much will it cost of Knee replacement surgery if you have insurance? And what if you do not have insurance then what is going to happen?

Earlier, we discussed Knee Replacement cost and what all expenses are included in that cost!

Now today, we will look at Insurance and Knee replacement. 

Typical Knee surgery cost with or without insurance includes the following charges:

  • Surgeon’s fees
  • Hospital Stay charges
  • Blood and Imaging work
  • Physical Therapy and Homecare
  • Home Modifications

Insurance Coverage for a Knee Replacement Surgery

Knee replacement insurance

Knee replacement surgery is covered by most insurance plans, including private health insurance, Medicare, and Medicaid.

Your doctor needs to prove the medical necessity of your knee surgery for it to be approved by your insurance. So it is advisable to contact your insurance provider beforehand to know about your Insurance coverage.

Usually, your doctor’s office will take care of all these things, but there is no harm in being involved and doing it proactively by your self.

Some of the questions you should ask are as follows:

  1. If your type of Knee replacement surgery covered? These include any exclusions which are not covered under insurance.
  2. Knee Replacement Preferred provider organizations- If your surgeon and hospital are not on the PPO list, your Insurance company might not pay for your surgery or will only cover part of it.
  3. If homecare and modifications are covered after Knee replacement surgery
  4. Physical therapy is vital after Knee replacement, and if home-based and outpatient physical therapy are covered.
  5. Coverage for Skilled Nursing facility since you might need to use it
  6. Preauthorization requirement or type of paperwork
  7.  Ask about all of your projected costs—including copays, deductibles for your Knee surgery.

In almost all cases though you have insurance for knee replacement surgery, you will need to fork out some money in the form of Copays, coinsurance, out of pocket expenses, and deductibles.

Understanding any limits on your coverage is very important. 

Out-of-Pocket Payments

Out of pocket expenses

Out of pocket payments for Knee replacement surgery depends on your health insurance coverage. 

Some of the ways you can reduce yours out of pocket payments are as follows:

  1. “Medigap” policy for Medicare beneficiaries 
  2. Other wellness accounts like FSA( Flexible spending account) and HSA( Health Spending Account)

As per, your maximum annual out-of-pocket cost for the year 2020 can’t be more than $8150 for individuals and $16300 for family coverage.

According to the 2017 Milliman Medical Index, out-of-pocket costs are rising, though many people are insured compared to before.

According to The Kaiser Family Foundation (KFF), health insurance premium costs have risen slowly, the deductibles and Max out of pocket payments have increased.

How did you pay for Knee Replacement Surgery?

Alternative to knee replacement

Have you recently undergone your Knee replacement surgery? How did you pay for it?

Sometimes cost of knee surgery can be prohibitively expensive for someone! Sometimes it is worth trying out alternatives to Knee Replacement.

Please share your experience by commenting below so others can understand how to pay for knee replacement surgery with insurance or without insurance.


Hi all. Welcome to my website I am Ankur Desai, a licensed physiotherapist in Brampton, Ontario, Canada. I have a special interest in musculoskeletal Physical therapy and more so in Knee rehab.

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