Paid for at the end.

If you are admitted to hospital for a knee replacement in 2026, traditional Medicare starts your share of the hospital bill with a single inpatient deductible: $1,736.¹ There is coinsurance on the surgeon's fees to come, but the operation itself is something the system knows how to pay for. It has a date, a code and a price.

The years before that day look nothing like it. Knee osteoarthritis rarely arrives as an event. It arrives as a bath you no longer trust yourself to climb out of, a staircase taken one step at a time, a chair you need both arms to leave. For most of that long middle, Medicare pays for some therapy and a few pieces of equipment. Much of what actually keeps a person moving at home is paid for by families, out of their own pockets.

What the middle years are covered for

Outpatient physical therapy is covered under Part B. After the annual Part B deductible, which is $283 in 2026, you pay 20% of the Medicare-approved amount.¹²

For years there was a hard annual cap on therapy spending. The Bipartisan Budget Act of 2018 repealed it.³ What replaced it is a threshold. In 2026, once a person's physical and speech therapy together pass $2,480, every further claim must carry a "KX" modifier, a statement that the services are medically necessary and supported by documentation in the medical record. Claims above the threshold without it "are denied".³ The cap is gone; the paperwork that guards the door is not.

Therapy does not have to make you better to be covered, either. Following a court settlement known as Jimmo v. Sebelius, Medicare states that coverage "does not turn on the presence or absence of a beneficiary's potential for improvement" but on the need for skilled care.⁴ For a condition that tends to progress, that matters. Yet the same rule draws the boundary: maintenance therapy qualifies when the services "cannot be safely and effectively carried out by the beneficiary personally, or with the assistance of non-therapists".⁴ The daily strengthening described in our piece on the thigh muscles is, almost by definition, something you do on your own.

Equipment follows the same logic. Part B covers walkers, including rollators, and arm and leg braces "when medically necessary", as long as a clinician orders them and, for equipment such as walkers, prescribes them "for use in your home". After the deductible, you pay 20% of the approved amount.⁵⁶ A walker is a medical item. The bathroom it has to fit into is not.

What it leaves out

Most of what makes a house liveable with a painful knee sits outside the programme. Medicare's home health benefit does not pay for "custodial or personal care" when that is the only care you need, for homemaker services such as shopping and cleaning that are unrelated to a care plan, or for 24-hour care at home. To qualify for home health at all, you must be homebound and need part-time or intermittent skilled care.⁷ CMS guidance for providers puts it plainly: Medicare "doesn't cover custodial care in the patient's home or an institution".⁸

Home adaptations fare no better. Original Medicare treats bathtub seats, grab bars, non-slip flooring and raised toilet seats as items for comfort or convenience, and it does not cover home modifications such as wheelchair ramps. Some Medicare Advantage plans offer allowances for safety devices.⁹

Powered exoskeletons were brought inside the system in 2024, but narrowly. CMS placed a powered bilateral hip, knee, ankle and foot device in the leg brace benefit category, described as a "lower body exoskeleton system worn to enable ambulation for user with disorders such as paralysis".¹⁰ Contractor guidance on the code, K1007, named a single product billed under it.¹¹ Nothing in that decision speaks to an older adult whose knees simply no longer lift her out of a chair.

What families pay instead

So households often buy the middle themselves. CareScout, a care-services company, has run an industry Cost of Care Survey for more than 20 years. Its 2025 edition puts the national median for a non-medical caregiver at home at $35 an hour, up 3% on the year before. At 44 hours a week, that comes to $80,080 a year.¹² The national median for assisted living is $6,200 a month; for adult day health care, $95 a day.¹²

Federal survey data on what older Americans spend show the same shape. In 2016 the average person in traditional Medicare spent $5,460 out of pocket on health care, premiums included, and the largest category of services was long-term care facility services, "which are not covered by Medicare".¹³ People aged 85 and over spent $10,307, more than twice the $5,021 spent by those aged 65 to 74.¹³

Where the out-of-pocket money went

Average out-of-pocket spending per person in traditional Medicare, 2016, US dollars

Premiums$2,294

Long-term care facility$1,014

Medical providers and supplies$712

Prescription drugs$651

Dental$449

Source: KFF analysis of the Medicare Current Beneficiary Survey (2019)

Some of the bill lands on the next generation. An AARP study released in 2021 found family caregivers spent an average of $7,242 a year of their own money, on average 26% of their income. Housing costs, including rent or mortgage, home modifications and assisted living, made up more than half of that spending.¹⁴ We wrote about what that work looks like from the inside in our piece on care at home.

A different line in Europe

Other systems draw the line in other places. In Germany, long-term care insurance can pay up to €4,180 towards adapting a home for people assessed at care levels 1 to 5, including permanently installed ramps, stairlifts and the conversion of a bathroom.¹⁵ It is still tied to an assessed need for care, not to the first difficult staircase. But it treats the home as part of care rather than a private matter.

None of this is an argument for or against surgery; that is a decision for a person and their clinicians. It is a description of who pays for what. (Where knee osteoarthritis spending goes, from injections to surgery, is the subject of a companion piece.) The American system pays readily for the operation at the end, pays modestly and with conditions for therapy and a walker along the way, and leaves the rest of the long middle to households.

Veema works on that middle: standing up, walking, staying at home. Whether an exoskeleton can help there is a question only studies with older adults can answer.

These figures describe the need. They are not results or claims about Veema.

Sources

1. Centers for Medicare & Medicaid Services, 2026 Medicare Parts A & B Premiums and Deductibles (2025): 2026 Part A inpatient hospital deductible of $1,736 and Part B annual deductible of $283.
2. Medicare.gov, Medicare Coverage of Outpatient Occupational Therapy, Physical Therapy and Speech-Language Pathology Services (publication 10988): After the Part B deductible, beneficiaries pay 20% of the Medicare-approved amount for outpatient therapy.
3. Centers for Medicare & Medicaid Services, Transmittal 13437, therapy KX modifier thresholds for CY 2026 (2025): Bipartisan Budget Act of 2018 repealed the therapy caps; 2026 KX threshold of $2,480 for PT and SLP combined; claims above it without the KX modifier are denied.
4. Centers for Medicare & Medicaid Services, Jimmo v. Sebelius Settlement Agreement fact sheet: Coverage does not turn on potential for improvement but on need for skilled care; maintenance therapy covered when it cannot be carried out by the beneficiary or non-therapists.
5. Medicare.gov, Walkers coverage: Part B covers walkers including rollators, medically necessary DME prescribed for use in the home, 20% coinsurance after the deductible.
6. Medicare.gov, Braces (arm, leg, back, neck) coverage: Part B covers arm, leg, back and neck braces when medically necessary and ordered by a provider, 20% coinsurance after the deductible.
7. Medicare.gov, Home health services coverage: Medicare does not pay for 24-hour care, homemaker services or custodial or personal care when it is the only care needed; eligibility requires homebound status and part-time or intermittent skilled care.
8. Centers for Medicare & Medicaid Services, Items & Services Not Covered Under Medicare, MLN booklet ICN MLN906765 (2020): Quote: Medicare Fee-for-Service doesn't cover custodial care in the patient's home or an institution.
9. AARP, Does Medicare cover home safety equipment?: Original Medicare does not cover bathtub seats, grab bars, non-slip flooring, raised toilet seats or home modifications such as ramps; some Medicare Advantage plans offer allowances.
10. Centers for Medicare & Medicaid Services, Transmittal 12684 (CR 13651), DMEPOS benefit category determinations (2024): Powered bilateral hip, knee, ankle, foot device categorised as Orthotic (Leg Brace), described as a lower body exoskeleton system for users with disorders such as paralysis, effective 2024.
11. Noridian Healthcare Solutions (JA DME), Powered Lower Extremity Exoskeleton: Correct Coding (2023): K1007 descriptor for a powered bilateral hip, knee, ankle, foot device; ReWalk named as the product coded K1007.
12. CareScout, Cost of Care Survey (2025): 2025 national medians: non-medical caregiver $35 per hour (up 3%), $80,080 a year at 44 hours a week; assisted living $6,200 a month; adult day health care $95 a day. Industry survey by a care-services company (data collected July to November 2025), not a government statistic.
13. KFF, How Much Do Medicare Beneficiaries Spend Out of Pocket on Health Care? (2019): Traditional Medicare only (MCBS Cost Supplement 2016): 2016 average out-of-pocket spending $5,460 including premiums; premiums $2,294, long-term care facility $1,014, medical providers and supplies $712, prescription drugs $651, dental $449; age 85+ $10,307 vs $5,021 for ages 65 to 74.
14. AARP, Caregiving Out-of-Pocket Costs Study, press release (2021): Family caregivers spent an average of $7,242 a year, 26% of income on average; housing including home modifications more than half of spending. Figures from the AARP press release; the release does not give sample size or fieldwork dates.
15. Bundesministerium für Gesundheit, Zuschüsse zur Wohnungsanpassung: Long-term care insurance can pay up to 4,180 euros for home adaptations for people at care levels 1 to 5, including ramps, stairlifts and bathroom conversion.