Joint replacement health insurance

Joint replacement is a fairly common procedure, especially for older Australians. Knee replacement and hip replacement tend to be the most common procedures. Fortunately, Medicare will partially cover the cost of most joint replacements, and private health insurance can both cover the costs and give you the option of shorter wait times for surgery.

Compare joint replacement health insurance

Below you'll find policies from Finder partners that include joint replacement and/or reconstruction. For pre-existing conditions (including arthritis) very policy has a waiting period of 12 months. 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...
HCF Hospital Silver Plus			Silver	$172.25		Go to Site More Info	Compare	loading Fetching your data...

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Is joint replacement covered by 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.

One of the downsides of getting joint replacement as a public patient is that there tend to be long waiting lists for surgery. With private health insurance, wait times are generally much shorter.

Is joint replacement covered by 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 joint replacement 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

The table below lists some of Australia's best health insurance brands that cover joint replacement. To compare coverage from even more health funds, use the free tool at the bottom of this page.

_{*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:

_{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.

Is arthritis a pre-existing condition for joint replacement?

Yes, arthritis is considered a pre-existing condition for private health cover, and will affect your waiting periods for joint replacement health insurance. Generally, this will add a 12 month waiting period.

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.