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.
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 NSW.
|Fund||Excess||Cost per month||Apply|
|White deluxe||$500||$138.95||Go to Site|
Mid Plus Hospital
|$500||$132.80||Go to Site|
|$500||$141.92||Go to Site|
Contents of this article
- 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.
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
- Physiotherapy fees to help with your recovery
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.
- 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.
|Health fund||Hospital policies that cover joint replacement *||Related services that are also covered|
*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.
|Health fund||Hospital policies that cover joint replacement*||Related services that are also covered|
|Cessnock District Health Fund|
|Health Care Insurance|
|Latrobe Health Services|
|Mildura Health Fund|
|Phoenix Health Fund|
|Queensland Country Health Fund|
|St. Lukes Health|
|CBHS health fund|
|Doctors Health Fund|
|Reserve Bank Health Society|
|Teachers Health Fund|
*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 23 September 2018.
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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