Does Health Insurance Cover Hip Replacement?

Posted on: Jul 16, 2025 | 3 mins | Written by: HDFC ERGO Team

Does Health Insurance Cover Hip Replacement?

Many people facing severe hip pain or arthritis consider hip replacement surgery as a final option when other treatments fail. But the big question remains: Does your health insurance cover hip replacement surgery? The good news is that most comprehensive health policies do cover hip replacement surgeries, provided they are deemed medically necessary by your doctor.

What is Hip Replacement?

Hip replacement, also known as hip arthroplasty, is a surgical procedure where a damaged or worn-out hip joint is replaced with an artificial implant. This surgery can alleviate pain, enhance mobility, and significantly improve quality of life. It is typically recommended when other treatments, such as physiotherapy, medication, or walking aids, fail to provide relief.

When Do You Need Hip Replacement?

You may need a hip replacement if:

• You have severe pain that interferes with daily activities, like walking or climbing stairs.

• Pain persists even while resting or sleeping.

• Non-surgical treatments no longer help.

• Hip joint damage severely limits your mobility.

Doctors usually evaluate your condition through X-rays, MRIs and physical exams to determine whether surgery is necessary.

What Causes Damage to Hip Joint?

Several factors can damage your hip joint and lead to the need for a replacement:

• Osteoarthritis:

This is the most common reason, where cartilage wears away over time.

• Rheumatoid arthritis:

An autoimmune condition that inflames the joint lining.

• Injuries or fractures:

A severe fall or accident can cause fractures that may not heal properly.

• Bone diseases:

Conditions like avascular necrosis can reduce blood supply, causing bone tissue death.

Lifestyle habits such as obesity and lack of exercise can also contribute to hip joint deterioration over time.

Does Mediclaim Cover Hip Replacement Surgery?

Yes, a mediclaim policy generally covers hip replacement surgery when it is medically necessary and recommended by a doctor. However, the claim will only be approved after the insurer checks your policy terms and the medical reports.

Some important points to remember:

• Pre-existing conditions:

There may be a waiting period of 2-4 years if the hip condition was pre-existing.

• Elective surgeries:

If the surgery is purely cosmetic or elective, it may not be covered.

• Sub-limits:

Some policies may have sub-limits or caps on specific surgeries.

Therefore, it is essential to review your policy details or consult with your insurer beforehand.

What Expenses are Covered by Mediclaim for Hip Replacement Surgery?

A typical mediclaim policy covers the following costs for hip replacement:

• Hospitalisation:

Room charges, nursing, ICU fees.

• Surgery costs:

Surgeon’s fees, anaesthesia, operation theatre charges.

• Diagnostic tests:

X-rays, MRIs, blood tests.

• Pre-and-post-hospitalisation:

Some expenses incurred before and after surgery are also covered.

• Medicines and consumables:

Medication and implants required for surgery.

However, it is essential to check the inclusions and exclusions in your policy to avoid surprises later.

How Much Does Mediclaim Cover for Hip Replacement?

The hip joint replacement cost in India typically ranges from INR 2 lakh to INR 5 lakh, depending on the hospital, city, and type of implant used.

Your policy cover will depend on:

• Sum insured:

The total amount insured under your health policy.

• Sub-limits:

Specific caps on joint replacement surgeries.

• Co-payment clause:

Some policies may require you to pay a percentage of the claim amount.

• Room rent limit:

Affects reimbursement if you choose a room beyond your policy limit.

Check your policy wordings carefully and talk to your insurer to know exactly how much your policy will cover.

Ensure Complete Coverage for Hip Replacement

Here are a few tips to ensure you get maximum coverage for hip replacement:

• Choose an adequate sum insured:

Opt for a higher sum insured to cover major surgeries like hip replacements.

• Understand waiting periods:

Know the waiting period for pre-existing conditions to avoid claim rejection.

• Check sub-limits:

Make sure there are no restrictive sub-limits for joint surgeries.

• Network hospitals:

Prefer hospitals within your insurer’s network for cashless treatment.

• Renew timely:

Always renew your health insurance policy on time to maintain continuity.

Conclusion

If you are planning a hip replacement or suspect you may need one in the future, review your policy now or consider upgrading to comprehensive coverage.

Disclaimer: The above information is for illustrative purposes only. For more details, please refer to the policy wordings and prospectus before concluding the sales.

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