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Joint replacement health insurance

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

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What you need to know

  • Joint replacements are covered under all gold hospital policies, as well as some silver plus policies.
  • Cover for joint replacements starts from around $41 a week.
  • Medicare will cover most of the cost in the public system, but surgery wait times are very long.

Compare joint replacement health insurance

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.

1 - 10 of 34
Name Product Treatments Price Apply
deluxe silver plus
Silver Plus$750 excess
  • Lung and chest
  • Back neck and spine
  • Cataracts
  • Joint replacements
  • Blood
  • Dental surgery
  • Palliative care
  • Pregnancy and birth
  • +27 other treatments covered
$153.20
per month
Medibank Silver Plus Security
Silver Plus$750 excess
  • Lung and chest
  • Back neck and spine
  • Cataracts
  • Joint replacements
  • Blood
  • Dental surgery
  • Palliative care
  • Pregnancy and birth
  • +27 other treatments covered
$157.12
per month
  • Lung and chest
  • Back neck and spine
  • Cataracts
  • Joint replacements
  • Blood
  • Dental surgery
  • Palliative care
  • Pregnancy and birth
  • +27 other treatments covered
$158.13
per month
  • Lung and chest
  • Back neck and spine
  • Cataracts
  • Joint replacements
  • Blood
  • Dental surgery
  • Palliative care
  • Pregnancy and birth
  • +27 other treatments covered
$160.07
per month
deluxe silver plus
Silver Plus$500 excess
  • Lung and chest
  • Back neck and spine
  • Cataracts
  • Joint replacements
  • Blood
  • Dental surgery
  • Palliative care
  • Pregnancy and birth
  • +27 other treatments covered
$160.25
per month
Silver Plus Hospital $750/$1500
Silver Plus$750 excess
  • Lung and chest
  • Back neck and spine
  • Cataracts
  • Joint replacements
  • Blood
  • Dental surgery
  • Palliative care
  • Pregnancy and birth
  • +25 other treatments covered
$162.43
per month
Medibank Silver Plus Security
Silver Plus$500 excess
  • Lung and chest
  • Back neck and spine
  • Cataracts
  • Joint replacements
  • Blood
  • Dental surgery
  • Palliative care
  • Pregnancy and birth
  • +27 other treatments covered
$164.92
per month
  • Lung and chest
  • Back neck and spine
  • Cataracts
  • Joint replacements
  • Blood
  • Dental surgery
  • Palliative care
  • Pregnancy and birth
  • +26 other treatments covered
$166.28
per month
  • Lung and chest
  • Back neck and spine
  • Cataracts
  • Joint replacements
  • Blood
  • Dental surgery
  • Palliative care
  • Pregnancy and birth
  • +27 other treatments covered
$166.37
per month
Silver Plus Hospital $750
Silver Plus$750 excess
  • Lung and chest
  • Back neck and spine
  • Cataracts
  • Joint replacements
  • Blood
  • Dental surgery
  • Palliative care
  • Pregnancy and birth
  • +27 other treatments covered
$167.59
per month
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Compare up to 4 providers

All prices are based on a single individual with less than $90,000 income and living in Sydney.

Is joint replacement covered by Medicare?

Joint replacements are partially covered by Medicare, but there will often be out-of-pocket costs in both the private and public system.

Public system

Public system

Medicare will pay for most 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 2019-2020, wait times were around 120 days for a hip replacement, and 223 days for a knee replacement.

Private system

Private system

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.

Is joint replacement covered by health insurance?

Joint replacement can be covered by private health insurance, but you will need to make sure that you get the right policy.

Hospital or extras? First, you'll need a hospital policy, rather than extras. A combined policy will work, but it will need the right level of hospital cover.

Hospital tier. Next, you'll need the right coverage level. Hospital cover comes in 4 tiers, and joint replacements are only mandatory with gold-tier policies. However, some lower tier policies (especially 'silver plus' policies) also have cover for joint replacements.

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

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.

Out-of-pocket costs for joint replacements

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.

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.

Waiting periods for joint replacements

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.

Health insurance waiting period

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.

Public hospital surgery waiting times

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, so the procedure has some of Australia's longest surgery waiting times. In 2019-2020, the wait time for a total hip replacement was around 120 days, and the wait time for a total knee replacement was 223 days. Going private can help you get surgery much sooner than this.

Frequently asked questions

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2 Responses

  1. 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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