Does health insurance cover joint replacement? Discover what benefits Aussie health funds offer.
Our joints run the risk of suffering wear and tear over time, and they can also be damaged by arthritis and a range of other medical conditions. This can eventually become so serious that the only treatment option is a joint replacement.
The good news is that private health insurance does provide cover for the cost of expensive joint replacement procedures. However, it’s important to shop around for a policy that provides the right type and level of cover for you.
- Which Australian health funds cover joint replacement?
- Is joint replacement covered by Medicare or health insurance?
- What costs will private health insurance cover?
- How much do Australians spend on joint replacement?
- How likely is it that I will need a hip or knee replacement?
- Compare policies that cover joint replacement and receive a quote from an adviser
Which Australian health funds cover joint replacement?
| Health fund | Hospital policies that cover joint replacement * | Related services that are also covered |
|---|---|---|
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| Australian Unity |
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*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 |
|---|---|---|
| ahm |
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| Australian Unity |
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| Budget Direct |
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| Bupa |
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| Cessnock District Health Fund |
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| CUA Health |
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| GMF |
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| GMHBA |
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| GU Health |
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| HBF |
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| HCF |
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| Health Care Insurance |
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| health.com.au |
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| hif |
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| Latrobe Health Services |
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| Medibank |
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| Mildura Health Fund |
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| nib |
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| onemedifund |
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| Peoplecare |
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| Phoenix Health Fund |
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| Queensland Country Health Fund |
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| St. Lukes Health |
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| Transport Health |
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| ACA Health |
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| CBHS health fund |
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| Defence Health |
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| Doctors Health Fund |
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| Navy Health |
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| Police Health |
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| Reserve Bank Health Society |
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| Teachers Health Fund |
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| TUH |
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*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.
Speak with an adviser about your policy options and get a quote
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
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 |
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| Knee replacements |
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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 policies that cover joint replacement and receive a quote from an adviser
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should knee & hip replacements be added to a travel policy if there has been no problems for 5 yrs or more
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 pre-existing conditions and travel insurance article.
All the best,
Richard