Thursday, November 30, 2023

Does Health Insurance Cover for Total Knee Replacement Surgery?

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The knees support the entire body weight and make movements easier. This is why bad knees can be troublesome, especially for older people. While opting for knee replacement surgery is the ultimate cure, the procedure can be costly. Meticulous health insurance planning before investing in a policy can save one from exhausting all savings. 


While many insurers allow policyholders to file reimbursement for knee surgery, a few offer additional coverage to simplify the treatment. Read this article till the end to know more.

Does Healthcare Insurance Cover Total Knee Replacement Surgery?

Yes, many insurance providers offer specialised insurance plans for knee replacement surgery. Knee surgery was previously considered a cosmetic procedure, which insurance typically did not cover. However, there has been a rise in the number of claims for knee replacements over the last decade. 


Consequently, some government-run insurance providers began offering special insurance for knee replacement surgeries. Private insurance companies have also followed suit and introduced their own insurance plans for knee replacements.


Policyholders should review their policy documents to ensure they receive the maximum coverage for such medical procedures.

What is Total Knee Replacement Surgery?

Individuals often encounter serious knee-related issues during later life stages. These issues can lead to osteoarthritis, knee injuries, or persistent knee pain. 


Orthopaedic surgeons may recommend knee replacement surgery, also medically called Arthroplasty. This surgical procedure involves the replacement of the entire damaged knee with an artificial joint and prosthesis.

What is the Cost of a Total Knee Replacement Surgery Cost?

The cost of getting a knee replacement surgery depends on various factors. The patient’s overall health, the procedure’s location, and any pre-existing knee conditions can significantly influence the associated expenses. Further, the prosthetics are often imported from other countries and thus can be expensive, resulting in a price range between ₹50,000 and ₹2 lakhs.


One must consider the following factors associated with knee replacement surgery during health insurance planning to make an informed choice:

  • Duration of the stay in the hospital
  • Requirement for therapy sessions during hospital stay or during recovery at home
  • Subsequent visits to the hospital for post-surgery check-ups
  • Transportation expenses
  • Any diagnostic tests or examinations following the surgery


It is essential to consider and assess how much of the expenses will the insurance policy cover for knee replacement surgery. The estimates will allow one to compare and evaluate the best health insurance plans and secure suitable coverage specifically tailored for the surgical procedure.

Things to Consider Before Getting a Total Knee Replacement Surgery

Multiple insurance plans are available to facilitate knee replacement surgery. However, their varying terms and conditions make a significant difference. Here are some factors to consider during health insurance planning to make an informed decision.

1. Specific Waiting Period

Many insurance policies impose a waiting period for pre-existing conditions, including knee-related issues that might require a replacement surgery. It is crucial to understand that it can vary between policies and insurers. During this waiting period, the policyholder would not be eligible for coverage related to knee replacement surgery or any complications.

2. Network Hospitals and Providers

Access to a network of hospitals and healthcare providers is critical. Policyholders must ensure that their chosen policy includes hospitals and surgeons with expertise in knee replacement surgery. It makes the process of receiving the necessary care more convenient.

3. Sub Cover Limit

There may be sub-limits or sub-cover limits specifically for knee replacement surgery or orthopaedic procedures in the overall insurance policy. These limits cap the maximum amount the insurer will pay for expenses related to knee replacement, which may include surgeon fees, hospitalisation costs, and rehabilitation expenses.

How can Healthcare Insurance Help in Total Knee Replacement Surgery?

An insurance policy provides compensation for expenses related to Arthroplasty. Some other benefits include:

1. Coverage for Medical Expenses

The policy provides coverage for in-patient hospitalisation costs, including fees for surgeons and room charges. Additionally, it extends coverage to medical expenses before and after the hospital stay.

2. Cashless Treatment Facility

Individuals can directly settle their hospital bills with the healthcare facility. It only requires selecting a hospital within the network and availing cashless treatment. 

3. Coverage for Complications or Revisions

Some comprehensive insurance policies cover potential complications that may arise after knee replacement surgery or the need for revision surgeries. It ensures that policyholders are financially protected if they require additional medical interventions due to unforeseen issues or complications related to the initial surgery.


A healthy lifestyle and regular workout can help maintain healthy muscles and bones. While no one has control over ailments, one must remain fit and active to keep illnesses at bay. It can take one to three months to regain strength and recover after a knee replacement surgery.

Investing in the best health insurance policy is ideal for individuals caring for elderly parents or family members. Niva Bupa the health insurance companies offers comprehensive insurance plans to facilitate hassle-free procedures. One can purchase the policy early to see through the waiting period and reimburse claims in the future.


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