Joint replacement health insurance

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

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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.

Name Product Joint replacements Tier Price Per Month Hide CompareBox Apply
ahm deluxe silver plus
Silver
$160.20
Qantas Silver Plus Hospital
Silver
$159.84
HCF Hospital Silver Plus
Silver
$172.25
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*Quotes are based on single individual with less than $90,000 income and living in Sydney.

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.

Health fundHospital 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
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

*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 procedureStatistics
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.

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.

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2 Responses

    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

      Avatarfinder 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 article on pre-existing conditions and travel insurance.

      All the best,
      Richard

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