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Health Insurance Cover for Knee Replacement Surgery - A Complete Guide
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A detailed guide on Health Insurance for Knee Replacement surgery

The knees play a pivotal role in your body as they give flexibility and mobility to nearby joints. But, at the same time, the knees are more susceptible to wear and tear. So, you should pay more attention to the knees while growing older. Moreover, knees support your body weight and bear the pain of poor postures and a sedentary lifestyle. These days, many people suffer from chronic knee pain because of strenuous activities or injuries, or health conditions like arthritis. Knee replacement surgery or arthroplasty is the utmost way to restore the functions of your knees. However, knee replacement surgery costs are Rs 50,000 to Rs 2 lakh, which is beyond the budget of many Indian households. Here comes a health insurance policy that covers the cost of knee replacement.

Thus, you should invest in the best health insurance plans that will support and protect you financially in the hour of need.

Many health insurance companies in India will allow you to file a reimbursement claim for your knee replacement surgery. But some will embrace you with the best health insurance policies in India that will cover additional coverage for your knee replacement surgery. So, before purchasing health insurance in India, always read the policy thoroughly and take a look at whether your policy covers health insurance for knee surgery or not.

Let’s take a deeper look at what knee replacement/arthroplasty is and why you need this surgery.

What is a knee replacement?

Most people usually get knee pain because of aging, obesity, a sedentary lifestyle, and many more. That’s why people are opting for knee replacement surgeries to re-establish the normal functionalities of the knees. Osteoarthritis is another leading cause of knee replacement surgeries in India. Apart from osteoarthritis, rheumatoid arthritis, ligament tears, injuries, and other cartilage defects are also responsible for knee pain and may damage your knees. People prefer knee replacement surgery when they can’t combat their prolonged pain and stiffness with other treatment methods like medications, physiotherapy, and so on.

A knee replacement is a delicate surgery where the experts usually replace your damaged bones and the cartilage with artificial joints or prosthetics. Before plunging into a knee replacement surgery, you should have adequate knowledge of various types of knee replacement surgery.

  • Total knee replacement: In this type of surgery, expert surgeons replace your entire knee with prosthetics.
  • Partial replacement: The surgeons usually perform this type of surgery for only the affected areas of your knees.
  • Bilateral knee replacement: In this type of surgery, the surgeons replace both your knees at the same time.


Since knee replacement is a severe problem thus, it is covered under most insurers’ critical illness insurance plans. 

When should you opt for knee replacement surgery?

  • People who are suffering from severe pain and dysfunction in one or both knees should opt for knee replacement surgery. For better analysis, your doctors will recommend some tests like X-Rays, MRIs, etc. to understand the condition and mobility of your knees
  • People who are having difficulties walking, climbing up the stairs, or feeling pain even in seated positions or resting must consider knee replacement surgery.


Based on your age, the severity of your pain, lifestyle, body weight, and other factors, your orthopedic surgeon will decide whether you need knee replacement surgery or not.

What is the cost of knee replacement surgery?

The cost of your knee replacement surgery depends on your overall health conditions, pre-existing illnesses, your selected place, and hospitals. The cost is near Rs 50000-Rs 2 lakh because these prosthetics are expensive and need to be imported from other countries. You can shun other additional costs while opting for knee replacement surgery. The other costs are,

  • Duration of stay at your chosen hospital
  • Physiotherapy if you need at the hospital
  • Post-surgery follow-ups
  • Any other therapy that you need for your recovery
  • Transportation cost
  • Additional medical tests and health check-ups


Consider all these parameters while calculating the costs of your knee replacement surgery. You can also give an idea of how much assistance you will get from your health insurance cover.

Does health insurance cover knee surgery?

Knee pains are excruciating and severe. A successful knee replacement surgery will help you to get rid of all the pain and discomfort. Moreover, you can again lead a pain-free and healthy life with the help of knee replacement surgery. But it is also true that knee replacement surgeries are expensive and will make a hole in your pocket. Thus, you should purchase the best health insurance for knee replacement to lessen your financial burden.

Always go for a health insurance policy that compensates your knee replacement surgery with an adequate sum assured. Here are some benefits of having health insurance for knee surgery.

  • Cashless treatment facility: If you select a network hospital of your insurer for your surgery, then your bills will be settled directly from the insurance company. For a hassle-free service, you need to schedule your hospitalization in advance.
  • Cover for treatment: A good health insurance policy from an eminent insurer will cover your pre and post-hospitalization, in-patient expenses, room rent, doctor’s fees, and so on. If you opt for the best health insurance for knee surgery, you don’t need to worry about the expenses.


Things to consider before opting for a knee replacement surgery

  • Earlier, knee replacement surgery used to fall under the category of cosmetic treatments or implants. But things are different for the Indian health insurance companies as many insurers offer reimbursement for knee replacement surgeries.
  • Before purchasing a health insurance policy for knee replacement, you should consider other things like the waiting period or whether this add-on facility will enhance your premiums or not, and so on. Because the waiting period is nearly 2-4 years for many insurance companies before you can make a claim for this treatment.
  • Though many insurance companies offer this cover, still, most of them usually bear half of the expenses for knee replacement surgery.


So, while purchasing a health insurance policy, don’t forget to check whether knee replacement is covered under the health insurance policy or not. Then, after comparing the policies from various insurers, choose the best one that resonates with your needs and requirements.

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