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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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Joint replacement is a fairly common procedure, especially for older Australians. Knee replacement and hip replacement tend to be the most common procedures. Fortunately, Medicare will partially cover the cost of most joint replacements, and private health insurance can both cover the costs and give you the option of shorter wait times for surgery.
Compare joint replacement health insurance
Below you'll find policies from Finder partners that include joint replacement and/or reconstruction. For pre-existing conditions (including arthritis) very policy has a waiting period of 12 months. Prices are based on a single policy in Sydney with $500 excess.
We update our data regularly, but information can change between updates. Confirm details with the provider you're interested in before making a decision.
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.
One of the downsides of getting joint replacement as a public patient is that there tend to be long waiting lists for surgery. With private health insurance, wait times are generally much shorter.
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.
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
- Physiotherapy fees to help with your recovery
The table below lists some of Australia's best health insurance brands that cover joint replacement. To compare coverage from even more health funds, use the free tool at the bottom of this page.
|Health fund||Hospital policies that cover joint replacement*||Related services that are also covered|
|Health Care Insurance|
|Latrobe Health Services|
|Mildura Health Fund|
|Phoenix Health Fund|
|Queensland Country Health Fund|
|St. Lukes Health|
*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.
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:
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.
Yes, arthritis is considered a pre-existing condition for private health cover, and will affect your waiting periods for joint replacement health insurance. Generally, this will add a 12 month waiting period.
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.
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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