Below are some of the cheapest policies from Finder partners that cover joint replacement - most are silver plus policies, rather than gold policies. To compare health insurance from 30+ funds, click here.
All prices are based on a single individual with less than $90,000 income and living in Sydney.
Medicare will pay for all of the cost of a joint reconstruction in a public hospital. There should be minimal out-of-pocket costs to pay, although there may be some, depending on your circumstances. The main downside of using the public system is that you'll have longer surgery wait times. In 2021-22, wait times were around 153 days for a hip replacement, and 293 days for a knee replacement.
In the private system, Medicare will pay some of the cost, but you'll need to cover the rest. Specifically, the Medicare Benefits Schedule (MBS) lists benefits for a wide range of joint replacements, but Medicare only covers 75% of the listed fee. That means you'll need to pay the remaining amount out-of-pocket or by using private health insurance.
Joint replacement is covered by all gold tier private hospital insurance policies but several silver plus policies will also cover you.
It can cover you for:
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.
Even with private health insurance, there will probably be an additional cost (or gap) that you will have to pay. The amount covered by health funds varies significantly, as does the amounts charged by surgeons. This can affect the out-of-pocket costs that you have to pay on top of your private health insurance, with the differences sometimes in the thousands of dollars. Make sure you speak to your health fund, GP and any prospective surgeon about the final cost of the surgery.
There are two types of 'waiting period' that are relevant to joint replacements, but the terms are similar. There's the health insurance waiting period then there are the public hospital surgery waiting times.
When you get private health insurance that covers joint replacements, there is a 2-month waiting period before you can make a claim. If you have a pre-existing condition (including arthritis) then you'll need to wait for 12-months before you can claim.
If you decide to use Medicare and get a joint replacement in the public system, then you'll have to wait for you surgery to be scheduled. Unfortunately, there are lots of public patients that need joint replacements, and waiting times have increased significantly since the COVID-19 pandemic. In 2021-22, the wait time for a total hip replacement was around 153 days, and the wait time for a total knee replacement was 293 days. Going private can help you get surgery much sooner than this.
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