Hip pain can gradually make everyday tasks like walking, bending or even resting more difficult. When medicines, injections or physiotherapy stop providing relief, doctors may suggest hip replacement surgery.
However, the big question for many is: does health insurance actually cover the cost of this procedure? Let’s break it down.
What is hip replacement?
Hip replacement is a surgical procedure that involves replacing a damaged hip joint with artificial implants. The aim of the surgery is to reduce persistent pain, restore mobility and make daily activities easier.
The hip joint has a shape like a ball and socket, and it allows smooth movement of the body. When this joint becomes worn out or injured, doctors may replace either one part or both parts with prosthetics made of metal, ceramic or plastic. In many cases, a complete replacement is carried out where both the ball and the socket are changed. Sometimes only the ball part of the hip joint is replaced, and it is called a partial replacement.
A revision hip replacement is a follow-up procedure performed when an existing hip implant wears out, loosens or fails, requiring it to be replaced with a new one.
When do you need hip replacement?
Doctors usually recommend hip replacement when daily life becomes difficult and other treatments fail. Some clear indicators include:
- Unbearable pain: Pain that continues between your hip and knee despite medication, physiotherapy or injections.
- Loss of mobility: Struggling with simple tasks like wearing socks, standing for a long time or walking short distances.
- Chronic stiffness: A persistent feeling of stiffness that makes it difficult to lift your legs.
- Failed conventional treatments: When painkillers, steroid injections or physical therapy no longer bring relief.
- Diagnostic tests: X-rays showing hip deformity or MRI scans revealing cartilage and tissue damage.
What causes damage to your hip joint?
Some of the most common causes of damage to the hip joint are:
- Osteoarthritis: This is one of the main causes of hip joint damage, and it happens when the cartilage that supports the bones begins to wear down with age. This results in pain, stiffness and reduced movement.
- Rheumatoid arthritis: It is an autoimmune condition where the immune system attacks its own tissue. The condition causes inflammation, swelling and long-term deterioration of the bone and cartilage.
- Osteonecrosis: This condition develops when the blood supply to the bone is reduced or cut off. This can cause death of bone tissue and progressive weakening of the joint.
- Post-traumatic arthritis: This form of arthritis often develops after an injury or fracture. The trauma eventually causes long-term stiffness, swelling and reduced flexibility.
- Childhood hip diseases: Developmental issues in the hip joint during childhood can lead to abnormal growth or deformity. It can later increase the risk of arthritis and joint issues in adulthood.
Does your health insurance cover the hip replacement surgery?
Health insurance can cover hip replacement surgery, depending on your plan. Some key considerations are:
- Medical necessity: Most policies cover hip replacement when a doctor confirms that the surgery is required for your health and mobility.
- Waiting period: Insurers typically apply a waiting period of 1–4 years for hip replacement, depending on the policy.
- Sub-limits: Some policies place a cap on the maximum amount they will pay for joint replacement surgeries, regardless of the total sum insured.
- Policy terms: The exact coverage depends on the clauses in your individual health insurance plan, so reviewing the document carefully is important.
What expenses are covered?
Hip replacement involves more than just the surgery itself, and most comprehensive health insurance plans take this into account. Coverage usually includes hospitalisation expenses such as room charges, nursing care and ICU fees, along with the surgeon’s fee, anaesthesia and operation theatre costs. Diagnostic tests like X-rays, MRIs and blood work done before surgery are also included.
Individual health insurance policies often extend to pre- and post-hospitalisation expenses too. This may cover doctor consultations, medicines and physiotherapy sessions. Policies usually cover medicines and implants, but many apply sub-limits, co-payments or exclusions on certain implants and consumables. However, coverage varies depending on the policy.
How to ensure complete coverage?
To ensure your hip replacement is fully covered, choose a policy with a high sum insured, verify the waiting period for joint replacement surgeries and confirm there are no sub-limits on the claim amount.
You also have to use hospitals within your insurer’s network to access cashless treatment, keep your policy renewed without gaps and always get pre-authorisation. These simple steps can help you avoid claim rejections and reduce out-of-pocket costs.
Conclusion
Hip replacement surgery can be life-changing for those struggling with chronic hip pain and mobility loss. While the procedure is costly, many health insurance plans provide coverage when it is medically necessary.
Understanding waiting periods, sub-limits and policy terms is key to avoiding surprises. By choosing the right plan, you can ensure financial protection and focus on recovery with peace of mind.
FAQs
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Does health insurance cover hip replacement surgery?
Yes, most health insurance plans cover hip replacement if it is medically necessary. However, the coverage can vary by policy, so review the terms carefully.
What is the waiting period in health insurance for hip replacement?
Individual health insurance usually has a waiting period of one to four years for hip replacement.
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Does individual health insurance cover all expenses of hip replacement?
Most individual health insurance plans cover hospitalisation, surgery and medicines. However, coverage depends on the policy terms.
Disclaimer: The information provided in this blog is for educational and informational purposes only. It is not intended as a substitute for professional advice, diagnosis or treatment. Please consult a certified medical and/or nutrition professional for any questions. Relying on any information provided in this blog is solely at your own risk, and ICICI Lombard is not responsible for any effects or consequences resulting from the use of the information shared.