Are upgraded implants for total knee replacement covered by insurance?

Hello,

If you are asking about an Ayushman Bharat PM-JAY knee replacement, total knee replacement is covered at an eligible PM-JAY-empanelled hospital after beneficiary verification and package approval.

The approved PM-JAY package includes a specified knee implant. The official package list separately specifies the implant component for primary total knee replacement.

However, if you specifically want an “upgraded” or premium implant that is outside the implant covered under the approved PM-JAY package, you should not assume that the additional cost will be covered. You have to pay separately for a non-covered upgrade, depending on the hospital and applicable scheme rules.

Documents Usually Required

Carry

• Ayushman Bharat PM-JAY Card

• Aadhaar Card/valid identity proof

• Orthopaedic surgeon's prescription

• Recent knee X-rays

• MRI or other reports, if advised

• Previous medical records

• Previous discharge summaries

• Current medicines/prescriptions

How to Check the Hospital

1. Open the official PM-JAY hospital search portal.

2. Select your State and District.

3. Search the hospital by its exact name.

4. Confirm its current PM-JAY empanelment.

5. Check that Orthopaedics/joint replacement services are available.

Important

Do not agree to an additional implant charge without first asking why it is being charged and whether the implant is outside the approved PM-JAY package. Knee replacement under PM-JAY is intended to be cashless for the covered package, but optional upgrades or services outside the approved package can be treated differently

How HexaHealth Can Help

We connect patients with suitable orthopaedic and joint-replacement specialists and partner hospitals and can assist with consultation, appointment coordination, treatment planning and understanding the Ayushman hospital process.

Please share your city and state

Wishing you and your family good health always.
Warm regards,
Team HexaHealth