Health insurance for joint replacement

If you need a joint 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.

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 with $500 excess.

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Name	Product	Joint replacements	Tier	Price Per Month	Hide CompareBox	Apply
ahm deluxe silver plus			Silver	$160.20		1300 670 233 Go to Site More Info	Compare	loading Fetching your data...
Qantas Silver Plus Hospital			Silver	$159.84		1300 641 719 Go to Site More Info	Compare	loading Fetching your data...
AAMI Silver Advantage Hospital Plus			Silver	$164.45		Go to Site More Info	Compare	loading Fetching your data...
HCF Hospital Silver Plus			Silver	$172.25		Go to Site More Info	Compare	loading Fetching your data...
Peoplecare Silver Plus Hospital			Silver	$177		1300 717 481 Go to Site More Info	Compare	loading Fetching your data...

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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

Health fund	Hospital policies that cover joint replacement*	Related services that are also covered
ahm	Top Hospital Deluxe Silver Plus	Joint reconstruction
Australian Unity	Ultimate Hospital (Gold) Advanced Hospital Classic Hospital	Joint reconstruction
Bupa	Gold Complete Hospital Silver Plus Advanced Hospital	Joint reconstruction
CUA Health	Premium Hospital Gold Premium Hospital Non-Obstetrics (Silver Plus)	Joint reconstruction
GMHBA	Gold Ultimate Hospital Gold Premium Hospital	Joint reconstruction
HBF	Gold Hospital	Knee and shoulder reconstruction
HCF	HCF Hospital Gold HCF Hospital Silver Plus	Joint reconstruction
Health Care Insurance	Gold Hospital Silver Plus Hospital
health.com.au	Core Hospital (Silver+) Bronze Plus Hospital Entry Hospital (Basic+)l	Knee and shoulder reconstruction
hif	GoldStar Hospital Silver Plus Hospital	Joint reconstruction
Latrobe Health Services	Gold Hospital Silver Plus hospital
Medibank	Medibank Gold Complete Medibank Silver Plus Security	Shoulder and knee reconstruction
Mildura Health Fund	Five Star Gold Basic Plus Benefit
nib	Gold Top Hospital Silver Advantage Hospital Plus	Joint reconstruction
Peoplecare	Gold hospital cover Silver Plus Hospital
Phoenix Health Fund	Silver Plus Advantage Hospital Silver Plus Content Hospital	Joint reconstruction
Queensland Country Health Fund	Better Hospital (Silver+) Cover	Joint reconstruction
St. Lukes Health	Gold Hospital Protector Silver Plus Hospital
Transport Health	Silver Plus No Pregnancy Silver Plus Select Hospital with Daily Excess Silver Plus Select Hospital with Excess	Joint reconstruction
ACA Health	Restricted health fund Gold Deluxe Hospital Basic Hospital
CBHS health fund	Restricted health fund Comprehensive Hospital Basic Plus Hospital	Knee, hip and shoulder reconstruction
Defence Health	Restricted health fund Ultimate Hospital Gold Advantage Hospital Silver Plus	Joint replacement
Doctors Health Fund	Restricted health fund Top Cover Gold Prime Choice Gold	Joint reconstruction
Navy Health	Restricted health fund Premium Gold Hospital	Knee reconstruction
Police Health	Restricted health fund Gold	Hip and knee reconstruction
Reserve Bank Health Society	Restricted health fund Gold Hospital Cover
Teachers Health Fund	Restricted health fund Top Hospital Mid Hospital Basic Hospital	Knee and shoulder reconstruction
TUH	Restricted health fund Gold Hospital Silver+ Family Hospital Silver+ No Pregnancy Hospital

_{*All hospital policies apply a two month waiting period to joint replacement and reconstruction claims unless treatment is due to a pre-existing condition, in which case the waiting period is 12 months. Data last confirmed as correct November 2020.}

How much do Australians spend on joint replacement?

As Australia’s population continues to age, the incidence of arthritis and a range of other joint issues continues to increase. Unfortunately, this also means that a rising number of Australians require hip and knee replacements. To give you an idea of the costs involved, lets look at some figures:

Joint procedure	Statistics
Hip replacements	In 2012-13, Australian private health insurance funds provided cover for more than 16,600 hip replacements, a 19% increase from 2011-12. Health funds paid total benefits of $414 million to cover hip replacements in 2012-13, with Victoria having the highest rate of benefit payments at $25,000 per hip replacement surgery.
Knee replacements	As for knee replacements, more than 25,000 knee replacements were covered by Australian private health funds in 2012-13, an increase of 41% from the previous year. This saw a total of $522 million in benefits paid, with Victoria once again recording the highest average benefit paid per surgery at $20,423.

_{Source of figures: https://www.privatehealthcareaustralia.org.au/variations-in-care-hip-and-knee-replacement/}

Average national cost for knee and hip replacements from 2012 - 2013

Without private health insurance in place, joint replacement surgery can cost a substantial amount of money, as can be seen below.

How likely is it that I will need a hip or knee replacement?

• Arthritis is the main contributing factor when Australians require joint replacement surgery. This debilitating condition affects more than 3.8 million Australians, and Arthritis Australia predicts that some 7 million people will suffer from arthritis by 2050.
• While arthritis is commonly seen as a problem that only affects the elderly, almost 2.4 million Australians who currently suffer from arthritis are of working age. With this in mind, it’s worth re-assessing your health insurance needs as you grow older and considering whether you might be able to benefit from a policy that provides comprehensive cover for joint replacements.

Compare 30+ policies and find cover for joint, hip and knee replacements

When you get your quotes on the next page, just click refine search and then choose joint replacement under hospital cover.

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