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Health insurance for joint replacement
Health insurance can help cover the cost of replacing your hips, knees and other joints.
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.
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
- Top Hospital
- White Deluxe
- White lite
- White boost
- White classic
- Joint reconstruction
- Platinum Hospital
- Gold Hospital
- Mid Hospital
- Clasic Hospital
- Advance Hospital
- Joint reconstruction
- Top Hospital
- Standard Hospital
- Budget Hospital
- Knee reconstruction
- Gold Hospital
- Silver Hospital
- Thrifty Hospital
- Premium Hospital
- Premium Hospital - Non-obstetrics
- Joint reconstruction
- Premium Hospital
- Bronze Hospital
- Joint reconstruction
- Hospital cover
- Top Hospital
- Knee and shoulder reconstruction
- Premium Hospital
- Mid Plus Hospital
- Mid Hospital
- Joint reconstruction
- Premier Hospital
- High Hospital
- Core Hospital
- Entry Hospital
- Knee and shoulder reconstruction
- GoldStar Hospital
- Silver Plus Hospital
- Joint reconstruction
- Top Hospital
- Member Share
- Cover Wise
- Loyal Members
- Family Care
- Complete Hospital
- Top Hospital Essentials
- Standard Hospital
- Shoulder and knee reconstruction
- Five Star Hospital Benefits
- Basic Hospital Benefits
- Top Hospital
- Joint reconstruction
- Private Plus Hospital
- Premium Hospital
- Mid Hospital
- Top Hospital $500 Excess
- Joint reconstruction
- Value Plus Hospital
- Public Hospital
- Joint reconstruction
- Hospital Platinum
- Hospital Budget 500
- Top Hospital Cover
- Basic Hospital
- Joint reconstruction
- Restricted health fund
- Deluxe Hospital
- Private Hospital
- Basic Hospital
- Restricted health fund
- Comprehensive Hospital
- Knee, hip and shoulder reconstruction
- Restricted health fund
- Premier Hospital
- Joint replacement
- Restricted health fund
- Top Cover
- Prime Choice
- Joint reconstruction
- Restricted health fund
- Premium Hospital
- Healthy Hospital
- Knee reconstruction
- Restricted health fund
- Top Hospital
- Hip and knee reconstruction
- Restricted health fund
- Gold Hospital Cover
- Restricted health fund
- Top Hospital
- Mid Hospital
- Basic Hospital
- Knee and shoulder reconstruction
- Restricted health fund
- Family Hospital
- Total Care Hospital
- 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.
- 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.
- 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.
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| Health fund | Hospital policies that cover joint replacement* | Related services that are also covered |
|---|---|---|
| ahm | ||
| Australian Unity | ||
| Bupa | ||
| Cessnock District Health Fund | ||
| CUA Health | ||
| GMHBA | ||
| GU Health | ||
| HBF | ||
| HCF | ||
| Health Care Insurance | ||
| health.com.au | ||
| hif | ||
| Latrobe Health Services | ||
| Medibank | ||
| Mildura Health Fund | ||
| nib | ||
| onemedifund | ||
| Peoplecare | ||
| Phoenix Health Fund | ||
| Queensland Country Health Fund | ||
| St. Lukes Health | ||
| Transport Health | ||
| ACA Health | ||
| CBHS health fund | ||
| Defence Health | ||
| Doctors Health Fund | ||
| Navy Health | ||
| Police Health | ||
| Reserve Bank Health Society | ||
| Teachers Health Fund | ||
| TUH |
*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 23 September 2018.
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 | |
| Knee replacements |
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?
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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Ask an Expert
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