Joint Replacement: Man assessed to see if he requires joint replacement

Health insurance for joint replacement

Health insurance can help cover the cost of replacing your hips, knees and other joints.

Whether you are replacing a simple joint like an ankle, or something more complex like a hip or knee, plenty of policies offer cover for joint replacements.

If you need the replacement because of a pre-existing condition like arthritis, your waiting period could be as long as 12-months. So start looking now if joint replacement is on the horizon.

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Compare private hospital cover for joint replacements

Below you'll find policies from Finder partners that include joint replacement and/or reconstruction. For pre-existing conditions, all have a waiting period of 12 months and prices are based on a single policy in Sydney, NSW with $500 excess.

You can find joint replacements, in a hospital policy of Gold tier.

Fund Policy Tier Price per month Apply
deluxe silver plus Silver $144.75 Go to Site
nib logo Image: Supplied Silver Advantage Hospital Plus Silver $147.04 Go to Site
Hospital Silver Plus Silver $153.35 Go to Site

*Price based on a single policy in Sydney, NSW.

Is joint replacement covered by Medicare or health insurance?

  • Medicare. Joint replacement surgery will usually be partially covered by Medicare, with the remaining gap to be covered by private health insurance hospital cover. The Medicare Benefits Schedule (MBS) lists benefits for a wide range of joint replacements; however, Medicare only covers 75% of the fee listed for a procedure, so you’ll need to take out private health insurance to cover the remaining costs.
  • Private health insurance. Some basic or lower-level hospital cover policies exclude joint replacements, so it’s important to choose a high-level hospital cover policy. In addition to hospital accommodation, theatre fees and charges from your doctor, your private health insurer will also cover the cost of the surgically-implanted prosthesis used to replace your joint. The Australian Government’s Prostheses List outlines all the prostheses for which private health insurers must pay a benefit.

What costs will private health insurance cover?

While health insurance can cover the cost of joint replacements, the level of cover provided varies substantially between health funds and individual policies. Some insurers will completely exclude joint replacements from lower tier hospital policies, while others will only pay a restricted benefit or cover specific joints such as knees. If you require health insurance for joint replacements you will need to take out a high-level hospital policy, which will generally include benefits for:

  • Accommodation in a public or private hospital
  • Theatre fees
  • In-hospital pharmaceuticals
  • Doctor and specialist fees
  • Prosthesis
  • Physiotherapy fees to help with your recovery

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2 Responses

  1. Default Gravatar
    BarbaraNovember 15, 2016

    should knee & hip replacements be added to a travel policy if there has been no problems for 5 yrs or more

    • finder Customer Care
      RichardNovember 15, 2016Staff

      Hi Barbara,

      Thanks for getting in touch. Pre-existing conditions are assessed on a case-by-case basis. If you would like to find out more, please consult our pre-existing conditions and travel insurance article.

      All the best,

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