Health Insurance Cover for Knee Replacement Surgery in India


6 min read

Our knee is an important joint in the entire musculoskeletal system. The support and strength of the knee are pivotal for fluid movement and locomotion. However, due to injury or degeneration, this joint loses its strength leading to excruciating pain, which hampers the quality of life. Knee conditions have become common, and knee replacement surgery is a beacon of hope. However, due to the rising cost of knee replacement surgeries, it has become essential to consider health insurance plans offering knee cover. Let us look at health policies covering knee surgery costs in India.

A knee replacement surgery offers us a chance to reclaim an active life and eliminate the pain associated with movement. Especially in the case of older adults, the challenges faced due to eroded knee cartilages significantly impact life and overall well-being. Thus most medical practitioners suggest knee replacement surgery as the ultimate cure. However, the sky-rising knee replacement surgery cost is unaffordable for many people. And even if one could afford the price, it might exhaust their savings.

So, the best thing to do is to look for health insurance plans offering coverage for knee transplant costs. Several health insurance companies allow policyholders to raise claims for knee replacement surgeries. However, some companies in India might cover knee replacement with critical illness insurance. Read on to learn about knee replacement surgery in India, also called arthroplasty, and if it is covered by health insurance.

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What is Arthroplasty/Knee Replacement Surgery?

Several factors lead to trouble in the knee joints of people. Ignoring minute issues like pains, falls, etc., in the initial phase of your life might cause you greater trouble later, especially during old age.

If you talk about the factors that cause chronic knee pain, aging, obesity, and an inactive lifestyle are among the common ones. On the other hand, a leading cause of knee surgeries in India is osteoarthritis. Many people face issues like aches or continued stiffness that cause them chronic knee pain, making it inevitable to go for knee replacement to bring normalcy to the knee functions. Further, ligament tears, rheumatoid arthritis, and cartilage defects can also cause knee damage requiring replacement in the long run.

So, what does a knee replacement surgery do? A knee replacement surgery replaces the damaged knee bone or the cartilage, causing trouble. It uses prostheses or artificial joints depending on the damage and the replacement required. For instance,

  • In total knee replacement surgery, the whole knee is changed, and prosthetics are used as a replacement
  • In case of partial replacement, only the affected area of the knee is taken into consideration
  • The process of bilateral knee replacement involves the replacement of both knees together

Buying critical illness insurance coverage helps lower the financial strain caused by this highly expensive medical treatment.

When do you need Knee Replacement Surgery?

Knee replacement surgery is generally recommended for people who experience severe dysfunction or extreme pain in one or both knees. Before starting the treatment, several tests, such as MRIs, X-rays, etc., are performed to assess the problem and its range. Some people find walking, climbing stairs, or getting up from a seated position difficult. These simple activities cause them severe pain. On the other hand, some people may even feel knee pain while in a sitting or resting position.

To know the condition of your knee, you must visit an orthopedic surgeon who can determine if you need a knee replacement surgery depending on different factors such as your age and weight, activity levels performed, as well as other health factors.

How much does a Knee Replacement Surgery cost?

The cost of knee replacement surgery in India depends on several factors, such as the patient’s overall health condition, the city/location where you are located, the hospital (private/government) where you want to get the surgery, etc.

If you are suffering from any other health condition or pre-existing diseases, it might also impact the surgery expense. Generally, the cost of knee replacement surgery for Indian residents can range between INR 1.8 lakhs to 4 lakhs depending on different situations, as mentioned above. Overall, these surgeries are quite expensive as in many cases, the prosthetics used in the surgery are imported from other countries.

Besides the above, one should also consider additional charges such as:

  • Duration of pre-and post-hospitalization or hospital stay
  • Physiotherapy required at the hospital after the surgery
  • Follow-up appointments that are needed
  • Additional costs during the recovery time at home
  • Additional tests, etc.

All these things should be considered while considering the expenses and how much of the costs are covered by your insurance policy. Thus, comprehensive health cover for your knee replacement surgery is recommended. Several health insurance companies offer policies covering knee replacement surgery in India (applicable for Indian citizens). Individuals willing to buy a plan must take care of the different costs per their needs and buy the most suitable policy.

Why Opt for Health Insurance Cover for a Knee Replacement Surgery?

Knee replacement surgery is recommended in case of severe knee issues. Individuals suffering from knee conditions and pain can be relieved of the same and lead a pain-free life by performing knee replacement surgery. But looking at the huge expenses and the complexity of the surgery, it is recommended to avail of a medical insurance policy that covers the costs of this treatment. Hence, consider buying a health insurance plan with an adequate sum insured to cover your knee replacement surgery.

Here are some benefits of a health insurance plan with knee replacement coverage:

1. Cashless treatment:

With a cashless treatment facility, you can get the payment of the hospital bills for knee replacement surgery directly settled by the insurance company. You can avail of this facility by getting your treatment done at a network hospital of your insurer. For smooth cashless treatment, it is recommended to schedule the surgery beforehand and inform your insurer accordingly.

2. Avail maximum cover for treatment:

With a comprehensive health plan, you can get coverage for pre- and post-hospitalization costs, room charges, surgeon’s expenses, in-patient hospitalization, and much more.

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To Conclude

Till recently, knee replacement surgery was categorized under cosmetic procedures. However, most health insurance companies in India now cover knee replacement.

Some important facts to consider before buying a health plan covering knee surgery. The waiting period under the policy is one such key consideration to note. Although this coverage is available with most insurers now, few might reimburse only half of the total cost of the treatment. Hence, discussing the same with the insurer before buying the plan is better. Some policies might apply longer waiting periods of 2 to 4 years before you could raise a claim. So, all these things are necessary to check and compare well while investing in a health insurance policy online for knee replacement coverage.

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FAQs: Health Insurance Cover for Knee Replacement Surgery

How much does knee replacement surgery cost in India?

Generally, the cost of knee replacement surgery in India for resident Indians ranges between INR 1.5 lakh to INR 3 lakh. However, it depends entirely on the hospital and the city where you plan to get the treatment done.

What is TKR in medical terms?

TRK, in medical terms, means total knee replacement, also known as total knee arthroplasty. This is a surgical procedure to heal a pained or troubled knee.

What is the knee replacement surgery cost in a government hospital?

Knee replacement surgery cost in government hospitals ranges between INR 1 to 2 lakhs.

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Jan 27, 2024
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PayBima is an Indian insurance aggregator on a mission to make insurance simple for people. PayBima is the Digital arm of the already established and trusted Mahindra Insurance Brokers Ltd., a reputed name in the insurance broking industry with 17 years of experience. PayBima promises you the easy-to-access online platform to buy insurance policies, and also extend their unrelented assistance with all your policy related queries and services.

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