Does Health Insurance cover Knee Replacement Surgery?

By Laxita Gautam
  | Published: 27 August 2021

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Arthritis and other joint-related issues are probably two of the most common and annoying health issues people face these days. The pain in joints often reaches a level where it is impossible to be treated simply with medicine. Such a situation may require you to undergo a complete knee replacement surgery. But undergoing a major surgery like this can become a huge toll on not only your mental state but also your wallet. It is genuine to wonder, “does health insurance cover knee replacement surgeries” in situations like this. The good thing is that, yes, most health insurance plans indeed offer coverage for knee replacement surgeries. But, as you may have suspected, this coverage may come with a bunch of underlying conditions and terms. Let’s examine the different types of knee replacement surgeries, what can lead to it, and how does health insurance covers knee surgery.

What is Knee Replacement Surgery?

Technically referred to as arthroplasty, knee replacement surgeries can be a result of several factors, osteoarthritis is one of the major ones. Most of these factors often go unnoticed due to their menial nature that’s how they cause trouble later. Apart from osteoarthritis, conditions like ligament tear and rheumatoid arthritis can also lead to knee troubles and surgery as well. Depending on the damages that your knees have incurred and the kind of replacement they need, knee surgeries can be divided into four types –

  • Complete Knee Replacement – When both joint faces at the end of the thigh bone and shin bone are replaced. Some surgeries may also involve the replacement of the patella, the surface under the kneecap.
  • Unicompartmental or Partial Knee Replacement – This surgery involves changing only the part of your knee that has been affected, generally by arthritis. It is generally the inner part of the knee that gets affected here and is changed in the surgery.
  • Kneecap Replacement – Only the under-part of the kneecap and the trochlea is replaced in this surgery.
  • Complex Knee Replacement or Revision Surgery – People with severe arthritis may need more complex surgeries which require several revisions. This surgery includes placing a longer stem in the knee to help keep the replacements in place or additional pieces to replace damaged bones. 

Does Health Insurance Cover Knee Replacement?

The simple answer to this question is, yes, knee replacement surgeries, like cataract surgeries, are covered by most health insurance plans despite not being an emergency surgical procedure. However, the inclusivity of this particular benefit completely depends on the providers and the plans that they are offering. You may also find that knee replacement surgery is covered in one plan offered by a certain provider but not in another one.

Is there a Waiting Period Applicable?

Since knee replacement surgeries are not emergency surgeries, they come with a waiting period in most health insurance plans. The same is the case for benefits like cataract surgery and pre-existing conditions. Most treatments that do not require immediate attention get a waiting period. The waiting period for knee replacement surgeries can range anywhere between 6 months to 2 years depending on the plan and providers.

When Do You Need a Knee Replacement Surgery?

Extreme damage to the bone, ligament, and joint may lead you to excruciating pain and dysfunctional joints and that makes knee replacement a necessity. Since the kneecap and other parts of the joint get replaced by artificial fixings, it is best to opt for the surgery as the last resort. Doctors generally recommend surgery only to people who go through extreme pain and discomfort even when performing general day-to-day actions like sitting, standing up, or walking. You are age, body fat levels, physical activity, bone health, skin health and many other factors are considered before suggesting knee replacement surgery. So, it is best to consult a doctor and get a fair idea in advance.

When Should You Opt for a Knee Replacement Insurance Cover?

Knee-related issues develop gradually over a period of time. This means that you will have enough time to not only get a health insurance plan with knee replacement cover but also to cover the waiting period. Keep a track of your knee health and get a fair idea of the situation. If surgery seems like a possibility, opt for health insurance that covers knee replacement in advance.

Conclusion

Health troubles generally come unannounced and most benefits offered by health insurance plans are to address such unforeseen, urgent situations only. Knee replacement is one of the few non-urgent benefits that insurance plans cover. Since you have the upper hand here by knowing the arrival of the surgery, stay another step ahead by buying health insurance knee replacement cover well in advance to save on these inevitable expenses. Keep a complete track of your health and realistically examine the situation to take viable actions

Laxita Gautam
Laxita Gautam137 Posts

Senior Content Writer | She functions on classic British fiction, Japanese manga, and strong americanos. Laxita is tailor-made to create engaging, interactive pieces that offer simplified insights into complex subjects.