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Health insurance for joint replacement

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

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If you need a joint 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 Sydney with $500 excess.

Data updated regularly
Name Product Joint replacements Tier Price Per Month Hide CompareBox Apply
ahm deluxe silver plus
Qantas Silver Plus Hospital
AAMI Silver Advantage Hospital Plus
HCF Hospital Silver Plus
Peoplecare Silver Plus Hospital

Compare up to 4 providers

*Quotes are based on single individual with less than $90,000 income and living in Sydney.

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
  • Health fundHospital policies that cover joint replacement*Related services that are also covered
    • Top Hospital
    • Deluxe Silver Plus
    • Joint reconstruction
    Australian Unity
    • Ultimate Hospital (Gold)
    • Advanced Hospital
    • Classic Hospital
    • Joint reconstruction
    • Gold Complete Hospital
    • Silver Plus Advanced Hospital
    • Joint reconstruction
    CUA Health
    • Premium Hospital Gold
    • Premium Hospital Non-Obstetrics (Silver Plus)
    • Joint reconstruction
    • Gold Ultimate Hospital
    • Gold Premium Hospital
    • Joint reconstruction
    • Gold Hospital
    • Knee and shoulder reconstruction
    • HCF Hospital Gold
    • HCF Hospital Silver Plus
    • Joint reconstruction
    Health Care Insurance
    • Gold Hospital
    • Silver Plus Hospital
    • Core Hospital (Silver+)
    • Bronze Plus Hospital
    • Entry Hospital (Basic+)l
    • Knee and shoulder reconstruction
    • GoldStar Hospital
    • Silver Plus Hospital
    • Joint reconstruction
    Latrobe Health Services
    • Gold Hospital
    • Silver Plus hospital
    • Medibank Gold Complete
    • Medibank Silver Plus Security
    • Shoulder and knee reconstruction
    Mildura Health Fund
    • Five Star Gold
    • Basic Plus Benefit
    • Gold Top Hospital
    • Silver Advantage Hospital Plus
    • Joint reconstruction
    • Gold hospital cover
    • Silver Plus Hospital
    Phoenix Health Fund
    • Silver Plus Advantage Hospital
    • Silver Plus Content Hospital
    • Joint reconstruction
    Queensland Country Health Fund
    • Better Hospital (Silver+) Cover
    • Joint reconstruction
    St. Lukes Health
    • Gold Hospital
    • Protector Silver Plus Hospital
    Transport Health
    • Silver Plus No Pregnancy
    • Silver Plus Select Hospital with Daily Excess
    • Silver Plus Select Hospital with Excess
    • Joint reconstruction
    ACA Health
    • Restricted health fund
    • Gold Deluxe Hospital
    • Basic Hospital
    CBHS health fund
    • Restricted health fund
    • Comprehensive Hospital
    • Basic Plus Hospital
    • Knee, hip and shoulder reconstruction
    Defence Health
    • Restricted health fund
    • Ultimate Hospital Gold
    • Advantage Hospital Silver Plus
    • Joint replacement
    Doctors Health Fund
    • Restricted health fund
    • Top Cover Gold
    • Prime Choice Gold
    • Joint reconstruction
    Navy Health
    • Restricted health fund
    • Premium Gold Hospital
    • Knee reconstruction
    Police Health
    • Restricted health fund
    • Gold
    • Hip and knee reconstruction
    Reserve Bank Health Society
    • Restricted health fund
    • Gold Hospital Cover
    Teachers Health Fund
    • Restricted health fund
    • Top Hospital
    • Mid Hospital
    • Basic Hospital
    • Knee and shoulder reconstruction
    • Restricted health fund
    • Gold Hospital
    • Silver+ Family Hospital
    • Silver+ No Pregnancy Hospital

    *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 November 2020.

    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:

    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 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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2 Responses

    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,

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