Knee Replacement Surgery Cost Even With Insurance

Knee replacement surgery also known as knee arthroplasty can help relieve pain and restore function in severely diseased knee joints. Every year, doctors perform 600,000 knee replacement surgeries on adults in the United States alone.

Knee replacement

The procedure involves cutting away damaged bone and cartilage from your; thighbone, shinbone and kneecap and replacing it with an artificial joint made of metal alloys, high-grade plastics and polymers.

Successful knee replacements allow patients to move more freely and remain active well into their old age, but the procedure comes at a hefty cost.

Reason for Knee Replacement

The most common reason for knee replacement surgery is to relieve severe pain caused by osteoarthritis. People who need knee replacement surgery usually have problems walking, climbing stairs, and getting in and out of chairs. Some also have knee pain at rest.

Risks

Knee replacement surgery, like any surgery, carries risks. They include:

  • Infection
  • Blood clots in the leg vein or lungs
  • Heart attack
  • Stroke
  • Nerve damage
  • Artificial knees can wear out

Signs of Infection

Notify your doctor immediately if you notice:

  • Fever greater than 100 F (37.8 C)
  • Shaking chills
  • Drainage from the surgical site
  • Increasing redness, tenderness, swelling and pain in the knee

An infected knee replacement usually requires surgery to remove the artificial parts and antibiotics to kill the bacteria. After the infection is cleared, another surgery is performed to install a new knee.

Another risk of knee replacement surgery is failure of the artificial joint. Daily use wears on even the strongest metal and plastic parts. Joint failure risk is higher if you stress the joint with high-impact activities or excessive weight.

Average Cost of Knee Replacement Surgery

For a total knee replacement surgery, patients can expect an average cost of just under $50,000. Although the final bill is dependent on several factors.

Knee replacement surgery costs vary based on; the number of days a patient is required to stay in the hospital post-operation, the type of implant used, any pre-existing conditions that may complicate the surgery, and care and recovery after the procedure is done.

Fortunately, individuals who have health care insurance usually do not pay the full knee replacement cost. However, there are still costs like a health insurance deductible, physical therapy or follow up visit co-pays, prescriptions, and expenses not covered by insurance that must be paid out of pocket.

To get a better understanding of what surgery will cost out of pocket for those with insurance coverage, it is beneficial to speak with the insurance provider to get a knee replacement cost estimate before going under the knife.

Financing Options for Knee Replacement Patients

For individuals who require a knee replacement surgery but do not have insurance, evaluating financing options prior to undergoing surgery is necessary. Here are a few options for covering the cost of knee replacement surgery.

Medical Bill Payment Plans

Some healthcare providers offer medical bill payment plans as a way to help patients pay for knee replacement surgery over time. Instead of paying the entire bill at once, payment plans break up the total amount due over the course of several months or even years, making repayment more affordable.

Patients should speak with their healthcare provider to see what payment plans are available, if interest is charged, and any other specifics of the repayment terms that may be included.

Personal Loans

Paying for out-of-pocket costs associated with knee replacement surgery may also be accomplished through a personal loan. This type of borrowing involves receiving a lump sum from a lender, typically a bank or credit union, which the patient then pays to the healthcare provider.

Monthly, fixed payments are made to the lender over the course of several months or years, providing predictability to repayment. Most personal loans have fixed interest rates which also helps with budgeting for repayment.

Revolving Accounts

Accounts like lines of credit and credit cards may also be used to pay for knee replacement surgery costs. While these types of funding are available, they carry variable interest rates which may increase over time. Interest rates on revolving accounts are also higher than fixed personal loans, increasing the total cost of repayment.

Payment Details Even With Insurance

The average cost for a $57,000. Using guidance on typical coverage levels from healthcare.gov, let’s assume your annual deductible is $1,300, your co-insurance is 20% and your maximum annual out-of-pocket cost is $4,400 a year.

Payment Details Even With Insurance

If this is the first medical procedure you’re having in a calendar year, at these levels of insurance, your total cost for the operation would be $4,400, your maximum out-of-pocket cost.

While $4,400 is a whole lot less than $57,000, coming up with the money to pay it could be difficult. And, remember, that’s just an example. It’s not uncommon for annual maximum out-of-pocket costs to be even higher.

Conclusion

Keep in mind that the cost of care and services is only part of the overall expense. For example, your doctor will also probably prescribe special equipment, such as a continuous passive motion machine, walker, or crutches.

Most insurance plans and Medicare cover these devices (referred to as “durable medical equipment”). However, they may lead to additional charges that appear on your hospital bill or another bill.

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