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Financial Considerations for the Younger Joint Replacement Patient

Here are a few financial points to consider if you’re young and struggling with joint pain.

More and more people between the ages of 45 and 64 (or even younger) are undergoing joint replacement surgery.1 While it's great that this younger demographic is getting the services they need to regain their active lifestyles, getting joint replacements in the earlier decades of life presents some different financial concerns compared to people over 65.

If you or a loved one under 45 are thinking about getting joint replacement surgery soon, there are some important things you shoulder consider.

2 Financial considerations for the younger joint replacement patient

1. Cost of surgery

Did you know? The average total cost of a total knee replacement surgery in 2020 in the U.S. was between $30,000 and $50,000.2 Figures are similar for total hip replacements. Many factors influence how expensive your surgery will be and how much of the cost is your responsibility to pay, including:

  • Your health insurance coverage, including whether your plan has co-pays, deductible, or co-insurance and whether you've already used other medical services during the plan year
  • The type of joint replacement you need
  • Whether you undergo your surgery as an "outpatient" or "inpatient"
  • Whether you experience any surgical complications
  • Your overall health

Your insurance company should be able to give you an estimated amount that you’ll be responsible to pay for after surgery. You also may want to figure in any additional costs associated with your pre-op and post-op appointments including X-rays, etc. Your insurance provider can also tell you what your deductible is, if you’ve met it yet, and what your copay might be. This can help you plan, and even save, for your procedure.

2. Downtime and recovery

It's important to honor your post-surgical rehabilitation period and not rush your healing process. For young patients—many of whom are still in the workforce and supporting their families through earned income—this probably means they'll have to take some time off work.

A few points to consider:

  • Can you arrange a medical leave of absence? Or use short term disability?
  • What if you run out of paid time off? Does your employer offer any other options?
  • If you're self-employed – how will you supplement your income?  Can you save money in advance?
  • What additional resources, such as childcare, housekeeping, or grocery delivery services might you need?
  • Are there places in your community that offer support to those undergoing surgery who need financial assistance?
  • Will you have rides to physical therapy, or will you need to use a taxi service?

If your employer closes or you lose your job before surgery, would you be eligible for COBRA3 (Consolidated Omnibus Budget Reconciliation Act), which "gives employees in certain situations the right to pay premiums for and keep the group health insurance that they would otherwise lose." (Call the Employee Benefits Security Administration at 1-866-444-3272 or visit their website at www.dol.gov/ebsa to learn more.)

These aren’t the only financial considerations when preparing for your recovery period after surgery. Make a list of anything you can think of that might cause financial strain during this time and discuss them with your doctor. 

If you're headed for a joint replacement surgery earlier in life, do what you can to prepare financially in advance. While the cost of joint replacement can seem overwhelming—especially when you have a job, a family, and an active lifestyle to get back to—there are resources that can help. Look into local charities and federal assistance programs. Talk to your insurance provider or hospital/clinic billing department about flexible payment options. And by all means, follow your doctor's instructions and do what you can to make your new joint last. For more information on associated risks of joint replacement surgery, click on the appropriate icon below and speak to your doctor.

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  1. (n.d.) The Risks of Early Knee Replacement. Arthritis Foundation. https://www.arthritis.org/health-wellness/treatment/joint-surgery/safety-and-risks/the-risks-of-early-knee-replacement-surgery
  2. (n.d.) How much doe a knee replacement cost? Here are 5 key factors. Tria. https://tria.com/cost-of-a-knee-replacement-surgery/
  3. (2019, May 13). COBRA: Keeping Health Insurance After Leaving Your Job. American Cancer Society. https://www.cancer.org/treatment/finding-and-paying-for-treatment/understanding-health-insurance/health-insurance-laws/what-is-cobra.html

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