Joint replacement health insurance
Health insurance can help cover the cost of replacing your hips, knees and other joints.
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.
All prices are based on a single individual with less than $90,000 income and living in Sydney.
Is joint replacement covered by Medicare?
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.
Is joint replacement covered by 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:
- Accommodation in a public or private hospital
- Theatre fees
- In-hospital pharmaceuticals
- Doctor and specialist fees
- 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.
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, 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.
Why you can trust Finder's health insurance experts
Our health insurance engine is completely free to use. You pay the same as buying directly from the health insurer. Better still, we regularly run exclusive deals that you won't find on any other site.
Unlike other comparison sites, we're not owned by an insurer. That means our opinions are our own and you can compare nearly every health fund in Australia on the site (and find a better deal).
Since 2014, we've helped 350,000+ people find health insurance by explaining your options simply. We'll never ask for your number or email to see prices. We're here to help you make a decision.
We're here to help
Frequently asked questions
- Finder: How long are public hospital waiting times?
- AIHW: More patients, longer waiting times for both elective surgery and emergency department care
- Sydney Morning Herald: Same surgery different surgeon: Huge variations in out-of-pocket costs for orthopaedic operations
- PrivateHealth.gov.au: Joint replacements - MBS items
- Services Australia: Health care and Medicare
- MBS Online: Changes to MBS items for orthopaedic surgery services
- Advanced Bone and Joint: Joint Reconstruction vs. Joint Replacement
- Harvard Health Publishing: Joint Replacement
- Data source: Private Health Insurance Ombudsman
- Icons made by Freepik from flaticon.com
More guides on Finder
Health insurance for sterilisation
Find out how to claim vasectomies and tubal ligation with Medicare or private health funds, and the things you should know before going in.
Medical costs comparison
Doing a medical costs comparison could save you a lot of money. Here's how to reduce your out-of-pocket medical expenses.
How does health insurance cover brain surgery?
Compare public and private health insurance for brain treatment.
Health insurance for cataract surgery
Find out the pros and cons of cataract surgery with both public and private healthcare.
Health insurance for grommets
Want to get health cover for grommets? Find out how private health insurance and Medicare costs compare and what you'll be covered for. Choose the option that suits you best.
Gold health insurance
Gold hospital insurance is the most comprehensive hospital cover that money can buy – starting from around $53 per week.
Health insurance for appendicitis
Wondering whether appendicitis will be covered by your health insurer? Your guide to private health insurance and appendicitis here.
How much does palliative care cost?
Palliative care is the practice of easing the pain of a patient with a terminal illness and making them as comfortable as possible before death.
Health insurance for cosmetic surgery
While private health insurance does not cover plastic surgery that is elective and performed for cosmetic purposes, it does provide cover for a wide range of reconstructive plastic surgeries.
Health insurance for insulin pumps
If your doctor has recommended that you receive an insulin pump, check with your private health fund to find out whether the cost will be covered under your policy.