Does insurance cover knee replacement surgery for seniors?

Dear Sumiunni Ji,

Yes, knee replacement surgery is covered under Ayushman Bharat Yojana (PMJAY). She can avail cashless knee replacement surgery at a PMJAY-empanelled hospital after beneficiary verification and treatment package approval.

If you are referring to private health insurance, coverage depends on your policy terms, coverage, and waiting period. You can check with your insurance provider to confirm your benefits.

What Is Covered Under Ayushman Bharat for Knee Replacement?

As per the approved PMJAY package, coverage include

• Orthopaedic specialist consultation

• Pre-operative evaluation and diagnostic investigations

• Knee replacement surgery (when medically advised)

• Operation theatre charges

• Surgeon and anaesthetist charges

• Knee implant (as covered under the approved PMJAY package)

• Medicines and consumables during hospitalization

• Hospital stay

• Nursing care

• Post-operative rehabilitation and follow-up care

Documents Required

• Ayushman Bharat (PMJAY) Card

• Aadhaar Card

• Doctor's prescription

• X-ray, MRI, or other relevant medical reports (if available)

• Previous medical records (if available)

How to Check Whether Knee Replacement Surgery Is Available Under PMJAY?

Online Verification

• Visit the PMJAY Hospital Finder.

• Select your:

  • State

  • District

  • Specialty: Orthopaedics

• Click Search to view PMJAY-empanelled hospitals.

How HexaHealth Can Assist You

• Ayushman Bharat Guidance: We help you understand the PMJAY eligibility and treatment process.

• Hospital Network: We connect you with trusted PMJAY-empanelled partner hospitals offering knee replacement surgery.

• Expert Consultation: We help you consult with experienced orthopaedic surgeons.

• Treatment Coordination: We assist with hospital selection, appointments, documentation, and treatment planning for a seamless experience.

Kindly Share the Following Details

To help you further, please share

• Your City and State.

• Does your mother have a valid Ayushman Bharat (PM-JAY) Card?

Please let us know whether your mother has an Ayushman Bharat (PMJAY) Card or private health insurance, and share your city. We will help you connect with an experienced orthopaedic surgeon and the best hospital based on her coverage.

We wish your mother a successful surgery and a speedy recovery.
Warm regards,
Team HexaHealth