Palm Beach County Hip & Knee Replacement
Insurance Accepted for Hip & Knee Replacement
Dr. Robert J. Avino is a board-certified, fellowship-trained orthopedic surgeon accepting Medicare and many major insurance plans for evaluation and treatment of hip arthritis, knee arthritis, and joint replacement surgery when appropriate.
Medicare Accepted
Many Major Plans Accepted
Military & Veteran Coverage
Insurance Network
Major Plans Accepted
Dr. Avino accepts Medicare and many major insurance plans for evaluation and treatment of hip and knee arthritis, including joint replacement surgery when medically appropriate. Coverage details vary by individual plan — the office can help confirm your benefits when scheduling.
Medicare
Medicare commonly covers medically necessary hip and knee replacement for patients with significant arthritis and functional limitations.
Aetna
Aetna commercial and Medicare Advantage plans may cover hip and knee replacement surgery when medically necessary criteria are met.
BlueCross BlueShield
BlueCross BlueShield plans commonly include coverage for joint replacement surgery for patients with advanced arthritis affecting function.
Cigna
Cigna commercial plans may provide coverage for hip and knee replacement when conservative treatment has been attempted and arthritis continues to limit function.
UnitedHealthcare
UnitedHealthcare commercial and Medicare Advantage plans may cover joint replacement surgery when medical necessity criteria are satisfied.
Humana
Humana commercial and Medicare Advantage plans may include coverage for hip and knee replacement when the procedure is determined to be medically necessary.
Additional Plans Accepted
Other Accepted Plans
Additional commercial plans accepted may include AvMed and First Health. Coverage details vary by individual plan. The office can confirm whether your plan is accepted when scheduling.
Military & Veteran Coverage
Military and veteran coverage options may include Tricare & Humana Military, Champ VA, and Optum VA Community Care. The office can help verify eligibility and benefits when scheduling.
Most Common Coverage
Medicare Coverage for Joint Replacement
Many patients considering hip or knee replacement in Palm Beach County are covered by Medicare. Medicare commonly provides coverage for medically necessary joint replacement procedures when arthritis leads to significant pain, functional limitations, and reduced mobility.
Patients with Medicare — including Medicare Advantage plans — may schedule a consultation to evaluate their hip or knee arthritis and discuss whether joint replacement surgery may be appropriate.
Medicare Part A & Part B
May cover inpatient hospital stay, surgeon fees, and post-surgical care for medically necessary joint replacement.
Medicare Advantage Plans
Many Medicare Advantage plans offered through Aetna, UnitedHealthcare, Humana, and others may also cover joint replacement. Coverage varies by plan.
Medigap / Supplemental Plans
Medicare supplement plans may help cover costs not fully paid by Medicare, such as deductibles, copays, and coinsurance. The office can help confirm your specific coverage.
How Insurance Coverage for Joint Replacement Works
Insurance coverage for hip and knee replacement typically requires that the procedure be deemed medically necessary. Here is a general overview of how coverage is evaluated.
Diagnosis
Coverage is typically tied to a documented diagnosis such as osteoarthritis of the hip or knee, degenerative joint disease, or bone-on-bone joint degeneration.
Conservative Treatment
Many plans require documentation that conservative treatments — such as physical therapy, medications, or injections — have been attempted prior to approving surgical coverage.
Authorization
Some insurance plans require prior authorization before joint replacement surgery is approved. Dr. Avino’s team can help manage the authorization process on your behalf.
Verify Your Benefits
Coverage details vary by individual plan. Calling the office with your insurance information is the most reliable way to confirm your specific benefits before scheduling.
Coverage details vary depending on the individual plan and the patient’s specific diagnosis. Our office can assist with benefit verification and authorization when scheduling.
Insurance & Coverage FAQ
Does Dr. Avino accept Medicare?
Yes. Dr. Avino accepts Medicare and many Medicare Advantage plans for evaluation and treatment of hip and knee arthritis, including joint replacement surgery when medically appropriate. Patients with Medicare may schedule a consultation to discuss their options.
Which insurance plans does Dr. Avino accept?
Dr. Avino accepts Medicare, Aetna, UnitedHealthcare, BlueCross BlueShield, Cigna, Humana, AvMed, and First Health, among others. Military and veteran coverage through Tricare, Humana Military, Champ VA, and Optum VA Community Care may also be accepted. Coverage varies by individual plan — calling the office is the best way to confirm your specific benefits.
Does insurance cover robotic joint replacement?
Most major insurance plans, including Medicare, cover joint replacement surgery based on medical necessity. However, some insurance carriers do not cover the robotic-assisted portion of your surgery, as they consider it experimental despite supporting clinical evidence. If your insurance does not cover this portion, you will be responsible for that fee prior to your surgery. Coverage is determined by your diagnosis and plan benefits.
What conditions does insurance typically cover for joint replacement?
Coverage is generally tied to a documented diagnosis such as osteoarthritis of the hip or knee, degenerative joint disease, bone-on-bone joint degeneration, or progressive cartilage loss that causes significant pain and functional limitations. A consultation with Dr. Avino can help determine whether your condition may meet the criteria for coverage.
How do I confirm my insurance coverage before scheduling?
You can call (561) 694-7776 and ask for Dr. Avino’s team. When you call, have your insurance card available so the office can verify your benefits and any referral or authorization requirements before your appointment.
Schedule a Consultation
If you have Medicare or another major insurance plan and hip or knee arthritis is affecting your mobility, a consultation with Dr. Avino can help determine whether joint replacement surgery may be appropriate. Our office can assist with benefit verification when scheduling.