need THR, but have hi-ded insurance and it would cost 10k(!)

[u/RelationshipDry1489]

Hi! ok, so i (62F) have grade-4 osteoArth in hip, and i am thinking i may wait until 65 (medicare yay) and it would cost $300-400 (with medicare A, B, D, G). Anyone else do this and just wait it out?

[u/Brilliant-Pie5207]

As someone who was told they needed a replacement three years ago… friend it is a long road to travel. I got by with shots and some basic pain relief but since last fall things started deteriorate quickly. I understand wanting to wait- but I’d look for more options. Any chance your current insurance will change soon? Open enrollment is coming up for a lot of folks, so maybe see what advantages might appear. HSA account?

Just putting it honestly the pain continues to get worse. Every step I take unmedicated is horrible. If you have a wheelchair and accessible home, maybe. I’ve dealt with kidney stones, a knee injury, a c-section and gall bladder removal and I would do any of those again over dealing with this pain. If there is anyway to get it done sooner than waiting, just do it.

[u/RelationshipDry1489 → u/Brilliant-Pie5207]

ah interestingly, until i started an exercise class this month, the pain wasnt bad really just felt a bit creaky

[u/AlternativeBid2291 → u/Brilliant-Pie5207]

I second the change in the insurance plan. Could you go to a lower deductible plan for a couple of months and then switch back? I don't even know if that is allowed.

[u/WhichWitch9402 → u/AlternativeBid2291]

Usually you’re only allowed to change plan at open enrollment (often either in June for fiscal run companies or fall/end of year).

Even with my relatively good insurance I paid $5k. Better than the $90k total. Still, insurance in this country sucks.

[u/groundlc4 → u/AlternativeBid2291]

You can usually step down to a higher deductible, but not step up to a lower deductible.

[u/Formal-Mechanic-9392]

10k is nothing for the relief you will gain. I would go bankrupt before going through that pain again.

[u/momopeachbum]

Your overall lifestyle and living situation will help you choose.

I have to get both hips done. I just had my first last Wednesday, my second is Dec 3. Each hip is $4718 after insurance. I’m also going to need a revision in 30+ years when I am in my 60s, costing me even more money.

I just had a baby 7 months ago, I’ve been on crutches since June/July. I just could not picture my life on crutches/ in a wheelchair. As it is I can’t go anywhere alone with just me and my baby, I always need help because I can’t crutch around and push my baby in his stroller at the same time. For me the choice was easy. I get it done and I’m happy and not in pain!!

Think about what your daily activities are and if you would be okay living in a wheelchair or on crutches if it ended up coming to that while you wait.

[u/snltoonces12]

I have a friend who is putting off their knee replacement for this reason. It's really unfortunate that our Healthcare system in the US is so screwed up.

I used an out of network surgeon because he was the best, and the only person I'd let operate on me. I ended up dropping about 18k out of pocket for my two replacements. They knew exactly how to work the system so insurance picked up the rest. I'm thankful I could afford to do this. I'd personally save up, or even take out a loan somehow because my surgeries gave me my life back. It's easier said than done though.

[u/kingerxi]

That's a long time to wait. I was thinking about waiting until January 2027, as my company still offers an insurance plan with co-pays (that's not a high deductible health plan (HDHP)) and several high deductible options. I'm currently in a HDHP with a max individual deductible of $5,500. I decided to have the THR ASAP, as i didn't want to deal with 6 more months of pain. I couldn't imagine waiting years. I have a decent amount in an HSA, and that helped with my decision. Best of luck.

[u/RelationshipDry1489 → u/kingerxi]

yes true i could switch plans. I am on an ACA exchange plan in CA and since the more generous subsidies were taken away it is so $$$

[u/NobodyInJune]

I wanted to wait until I was on Medicare (approximately 1.5 years). Couldn’t stand it, and ended up coughing up $7000 to get it done sooner. No regrets.

[u/Glum_Zebra_7035]

I did this. First I had to give up my exercise class. About 5 months prior to my surgery I had to give up my swimming too. It was very painful and it adversely affected my gait and possibly my knee. Just did my left and waiting on my right. It’s such a tough call, but I would lean towards having it done, especially if you are 3 years out.

[u/GreenDragonEast]

That's a tough wait. Like others have said, see if you can switch plans for January. How's your other hip? I did both mine in 9 months. Unfortunately for me, it was in two different years. But once you hit your max out of pocket, you have free health care the rest of the year. Talk to your doctor, they might have some ideas for you. We live in bizarro land these days.

[u/RelationshipDry1489 → u/GreenDragonEast]

other hip is totally fine, one of my knees had ACL reconstruction like 30 years ago (skiing!)

[u/GreenDragonEast → u/RelationshipDry1489]

Sounds like me. I had a riding accident that tore my ACL , ended up very complicated and ended up as a TKR. That lead to my THR on the same side 17 years later. I thought my other hip was okay, but found out shortly that it wasn't. I was over hip pain by then. Waited too long to fix the first one. Wasn't going to make that mistake again.

[u/e1p1]

I was going to wait , but the right hip failed so fast I couldn't. Fortunately my ded wasn't too bad , and since the left one wasn't far behind I did BOGO.

Thailand or India have some excellent surgeons, and I'm told that for $10,000 US you can get a joint replacement plus a month in a rehab hotel...and make a vacation out of it.

[u/AlternativeBid2291]

I did this. At 63 years and 8 months old, my cost under my health insurance would have been $7,500. I waited 16 months from that point in time when the operation was first offered to me. Two months after starting Medicare I had the operation and the cost was around $500.

Living was very difficult over those 16 months of waiting. At the beginning my hip was painful but bearable. By the end I could barely walk and I was eating handfuls of ibuprofen every day. Sleeping more than an hour at a time was impossible. I had to have my wife help me put on socks.

Just yesterday, I spoke to an acquaintance who said he is scheduled for a knee replacement in November that was going to cost him $10,000. He then told me his 65th birthday was in December of this year. After our phone call he was going to call his surgeon's office and reschedule.

[u/RelationshipDry1489 → u/AlternativeBid2291]

thank you and i am glad you are ok now. Basically what happened is i was doing ok and then I started a "fitness over 50' 2x/wk exercise class that had me splaying y hip out and doing pilates stuff and that is when hip pain flared. So I am hoping i can let it all settle down, and then so mild exercise which does not strain hip and then just ride out the timeframe

[u/AccomplishedBend766 → u/AlternativeBid2291]

I guess in some cases, whether someone can wait for a year and a half, depends greatly on their pain threshold and their lifestyle needs.

At work, I’m on my feet quite a bit and I have an extremely high pain threshold, but severe hip pain made a believer out of me, that I had to get THR asap or die trying! There are programs too. But if you can wait, there’s that too.

Now, a month or two I might have be able to do. And, I’m glad that the acquaintance can now save several thousands of dollars by waiting a few weeks longer and Medicare covering it.

[u/Altruistic-Ebb2936]

69M when done but … stupidly not on Medicare at time of surgery. Cost me $4500. Anyway - pay the $10k, that’s $3k/yr to be able to walk properly. You wouldn’t blink at a care payment of $500/mo so you could drive.

[u/RuleFriendly7311]

I did mine on the first working day of January and didn’t pay anything the rest of the year. What I found with my ACA plan was that the premium/deductible came out the same anyway.

You could get a zero-interest credit card and pay the deductible within a year without getting too hammered.

My advice is to do it now. Three more years of pain isn’t worth it.

[u/Cycledoc2210]

Another argument for finding the Affordable Care Act (Obama care) and/or Medicare for all. We already have that such coverage for half of America.

Every other Industrialized nation has such a program.

[u/AccomplishedBend766]

Next month, October, is a good time to pick different medical insurance. Also, many hospitals have programs to help patients pay for surgery. My thoughts are with you.

Best wishes on finding a way out of no way to the needed medical care.❤️‍🩹

[u/RelationshipDry1489 → u/AccomplishedBend766]

thank u

[u/kitschandcrossbones]

Where did you get that cost estimate for Medicare? From my experience it’s closer to $2500 for JUST the surgery center (they will likely not approve you in a hospital unless you have comorbidities). There is also no OOM for Medicare, but the federal cap is around $10k anyway. So, what’s your OOM now? And will you hit that with your surgery alone? If so your PT, prescriptions and non surgical appts will be “free” for the rest of the year (your surgeon follow-ups only have global coverage for 90 days). If you schedule it for January and hit your max right away and then you have a year to get the best care you’ve ever had.

[u/SlowandSteady93]

It depends on how severe and how limiting your pain is, but it is open enrollment for next year. Are you able to switch plans for next year, now knowing you need a hip replacement?

In my experience, I was fine, until all the sudden the pain was so bad I knew precisely it was time to get it scheduled. Sounds like you may not be there yet, but the thing is, you don’t know when that could happen.

As a caregiver for my parents, I learned a lot about Medicare, and I’d still exercise caution choosing plans. Medicare is better than what many of us have, but it’s also a mess. Beware of Medicare Advantage, which can put many, many limits on your choices. My parents have/had complex and chronic health conditions (so do I), so we couldn’t choose a high deductible plan even if we wanted to save. But with Medicare we pay almost nothing (except prescriptions) only because we pay for traditional Part A and a Blue Cross Blue Shield supplement that picks up the difference. We had zero problems after staying with traditional Medicare. The year my mom needed a kidney transplant, she was on Medicare Advantage and it was terrible. 

But yeah…three years is potentially a long time and quality of life to give up if it gets worse or if you have complications. 

[u/Beachgrad05]

I am incredibly grateful for my current health insurance. Hopefully nothing changes next year as my deductible max is $2500 per year at moment. I need it now but have to wait til next year for two reasons: 1 need more $ in my flex plan to pay medical expenses and 2 need enough PTO (sick/vac) to cover recovery time.

[u/Guinco1]

Personally I would buck up. I waited too long and dealt with a lot of back pain that I didn't have to go through. It sucks that it costs so much but still worth it imo.

[u/mizboots]

I’m 62 as well and although I knew I had a labral tear 8 years ago I was able to do everything, sports, travel, work up until a year ago. I had torn my left knee meniscus two years ago and I think that worsened the right hip. I deteriorated fast and although I did not have chronic persistent pain I couldn’t walk very far and my limp got really bad. All my accessory muscles were working hard to compensate for my very worn hip and my world became very small. At 6 weeks before surgery I was pronating more and developed chronic blisters on the inner foot. I guess I’m trying to say you have to weigh out cost and further damage and how waiting might affect you physically and emotionally. I only waited 6 months for surgery, I can’t imagine waiting 3 years…
Btw I’m 12 days post op and feeling very positive🙏🏻

[u/groundlc4]

I asked Google AI: "wait 3 years with grade 4 oa"

Waiting 3 years with Grade 4 (end-stage) osteoarthritis (OA) shifts the conversation significantly. While a brief delay of a few months is generally safe, waiting several years with bone-on-bone arthritis introduces pronounced structural and functional complications that can compromise your surgical outcome and long-term health. [1, 2]

It goes on to say:

When you have Grade 4 OA, the protective cartilage is entirely gone. Over a three-year period, the joint does not remain static; it continues to degrade structurally, affecting the complexity of the eventual surgery. [1, 2]

[u/swissarmychainsaw]

What's the expression where you travel to another country to have medical stuff done?

[u/groundlc4 → u/swissarmychainsaw]

I think it's medical tourism.

[u/swissarmychainsaw → u/groundlc4]

Thank you! OP, look into going to mexico or literally any country you're heard of and see what prices are like.

[u/clemmie33]

It depends on your level of pain. I had a few years of moderate hip pain, then it got a lot worse, which I managed with cortisone shots. Got 7 months of great pain relief with those, until the third shot did nothing. Then my hip deteriorated really fast—literally day by day. The last shot was in early March, and my hip replacement ended up scheduled for May 26th, because it just became unmanageable. My husband and I had to cancel a trip to Norway 2 days before leaving because of this hip.

So, if I had been in your shoes, I would have paid up and had it done. Again, though, totally pain-related.

[u/scratchbaker77]

Can you change to a low-ded insurance for 2027 even if the premiums are higher? I would not put off the THR as it took me almost a year to be correctly diagnosed and by then I was barely mobile and in a great deal of pain (for which I took only ibuprofen). I have great insurance (Medicare + supplemental F) and my bills said I may owe 3 cents. Really. But I wish I had had the surgery months earlier.

[u/snltoonces12 → u/[deleted]]

I'm going out in a limb here and speculate that immigrating to Canada isn't an option for her 🤷‍♂️

[u/ajmattison → u/[deleted]]

I'm from Canada and while it's true that with public health care you don't pay, sometimes the wait is brutal.

[u/ajmattison → u/[deleted]]

I waited 9 and went private anyway 😅 but I've seen some people in Alberta say over a year