Most health insurance plans—including Medicare and Medicaid—cover knee replacement surgery. If your insurance plan covers it, your doctor will need to establish that it is medically necessary. It can help to know exactly what your doctor must document to show this.

Are knee replacements covered by insurance?

Most health insurance plans—including Medicare and Medicaid—cover knee replacement surgery. If your insurance plan covers it, your doctor will need to establish that it is medically necessary. It can help to know exactly what your doctor must document to show this.

What is the criteria for a total knee replacement?

• Severe knee pain that limits your everyday activities.
• Moderate or severe knee pain while resting, day or night.
• Long-lasting knee inflammation and swelling that doesn’t get better with rest or medications.
• A bowing in or out of your leg.
• No pain relief from NSAIDs or can’t tolerate them.