Hip pain after 65 is one of the most common reasons older adults start limiting the activities they love.
Maybe stairs have become a negotiation, or a full night of sleep now depends on which side you choose. I talk with Medicare beneficiaries every week who waited months before mentioning it to a doctor. Waiting carries two kinds of cost: your mobility and your money.
This guide explains when hip pain deserves a doctor visit, how Medicare handles hip replacement, and how to keep your share of the bill small.
When to See a Doctor for Hip Pain After 65
Some hip pain is ordinary wear and tear, but certain symptoms should never be ignored.
Call your doctor promptly if you notice any of these red flags:
- Pain at night or at rest, not just with activity
- Pain that began after a fall or other injury
- Inability to bear weight on the leg
- Stiffness that lasts more than a few weeks
Pain after a fall, or any inability to bear weight, deserves urgent care or an emergency room visit the same day. The other symptoms warrant a scheduled appointment with your primary doctor. Medicare Part B pays for that visit like any other medically necessary appointment.
When in doubt, make the appointment, because early answers almost always mean easier treatment.
Common Causes, and What Doctors Try First
Most hip pain after 65 traces back to a handful of familiar causes.
Osteoarthritis is the most common, according to the National Institute on Aging. Bursitis, hip fractures, and pain referred from the lower back round out the usual suspects. Your doctor will typically start with conservative care: physical therapy, anti-inflammatory medication, or injections.
Before your appointment, jot down when the pain occurs, what makes it worse, and any medication you have tried. Those three notes help your doctor pinpoint the cause faster. They also create the paper trail Medicare uses to establish medical necessity later.
Surgery only enters the conversation when conservative treatment stops working.
How Medicare Handles Hip Replacement
Medicare pays for hip replacement when your doctor certifies it as medically necessary.
If your surgery is performed as an inpatient, Medicare Part A pays after you meet the $1,736 deductible per benefit period, per the 2026 CMS cost figures. If your surgery is outpatient, Medicare Part B pays for the procedure, surgeon fees, and physical therapy. With Part B, you first meet the $283 annual deductible, then owe 20% of the Medicare-approved amount.
If recovery requires a skilled nursing facility, Medicare pays in full for days one through 20. A daily coinsurance of $217 applies for days 21 through 100.
Which part pays, and what you owe, depends entirely on how your surgery is billed.
The Shift to Outpatient Surgery
More than half of joint replacements are projected to become same-day, outpatient procedures.
The American Academy of Orthopaedic Surgeons notes that healthy patients increasingly go home the same day. That shift moves your cost from Part A to Part B. Instead of one flat deductible, you owe 20% of the full outpatient bill.
Ask your surgeon which setting is planned, because the answer changes your math.
Before you schedule surgery, request a free side-by-side Medigap quote comparison to see what Plan G and Plan N would cost in your ZIP code.
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What a Hip Replacement Could Cost You
The numbers make a strong case for planning ahead.
A total hip replacement commonly runs $30,000 or more before Medicare pays anything, and Healthline, citing the American Association of Hip and Knee Surgeons, reports a range of $30,000 to $112,000. On an outpatient procedure, your 20% Part B share can reach several thousand dollars. For a retiree on a fixed income, that is not a rounding error.
You can preview facility-specific estimates with the Medicare.gov Procedure Price Lookup tool.
What If You Have a Medicare Advantage Plan?
Medicare Advantage members follow a different cost structure entirely.
Your plan sets its own copays for surgery, facility fees, and physical therapy, and those amounts vary by plan and county. Network rules also determine which surgeons and hospitals you can use. Before scheduling, ask your plan for its specific joint replacement costs in writing.
Knowing your plan’s numbers ahead of time removes the biggest surprise from the whole process.
How a Medigap Plan Changes the Math
A Medicare supplement plan exists for exactly this situation.
These plans pay most or all of the Part A deductible and the Part B 20% share, depending on the plan letter you choose. What many people do not realize is that Medigap plans are standardized by federal law. A Plan G from one company is identical in benefits to a Plan G from another company.
The differences come down to pricing and service, and my job is to find you the best price for the same benefits.
Timing Matters: Your Medigap Enrollment Window
The best time to buy a Medigap policy is during your six-month open enrollment window.
That window begins the first day of the month in which you are both 65 or older and enrolled in Medicare Part B. During it, companies must accept you at the best available rate, regardless of your health history. Outside that window, medical underwriting may apply in most states.
If you already have hip problems, confirm your Medigap options before you schedule surgery. This is a factual deadline, not a sales tactic, and it is worth checking your status today.
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Frequently Asked Questions
Q: Does Medicare pay for hip replacement?
A: Yes, when your doctor certifies the surgery as medically necessary. Medicare Part A pays for inpatient procedures after the $1,736 deductible per benefit period. Medicare Part B pays for outpatient procedures after the $283 annual deductible, and you owe 20% of the Medicare-approved amount.
Q: When should I see a doctor for hip pain?
A: See a doctor if hip pain occurs at night or at rest, follows a fall, prevents you from bearing weight, or brings stiffness lasting more than a few weeks. Pain after a fall, or an inability to bear weight, deserves urgent care the same day.
Q: How much does hip replacement cost with Medicare?
A:The full procedure often exceeds $30,000 before Medicare pays. Your share depends on the setting: roughly the $1,736 Part A deductible for inpatient surgery, or 20% of the approved amount for outpatient surgery. A Medicare supplement plan can reduce that share to little or nothing.
Q: Can I get a Medicare supplement plan if I already have hip pain?
A: It depends on timing. Inside your six-month Medigap open enrollment window, acceptance is guaranteed at the best available rate. Outside that window, most states allow medical underwriting, so a hip condition could affect approval or price. Confirm your options before scheduling surgery.
The Bottom Line
Hip pain after 65 is your body asking for attention, and the smartest response protects both your health and your finances.
See your doctor early, understand how your surgery will be billed, and review your Medicare setup while you still have the most options. The biggest financial variable is not the procedure itself. It is whether a Medicare supplement plan is in place before surgery is scheduled.
Schedule a free consultation with me, Leslie Alford, at 720-943-6321. We will walk through exactly what a hip replacement would cost under your current Medicare setup, and whether a Medicare supplement plan could reduce that amount to nearly zero.
For Further Reading:
Leslie Alford is a Personal Benefits Manager at MediGap Advisors. Leslie has a passion for bringing clarity to those confused about Medicare. She is an authority on Medicare, Medicare supplement plans, Medicare Advantage plans, and Part D prescription drug plans. Read more about Leslie on her Bio page.