Health insurance for joint replacement

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.

Provider	Policy	Tier	Price Per Month	Apply
	Base Hospital Co-Pay	Bronze	$81.78	Go to Site
	Deluxe Silver	Silver	$144.75	Go to Site
	Silver Plus Hospital	Silver	$145.64	Go to Site
	Silver Advantage Hospital Plus	Silver	$147.04	Go to Site
	Silver Plus Security	Silver	$147.30	Go to Site
	Silver Advantage Hospital Plus	Silver	$147.04	Go to Site
	Silver Advantage Hospital Plus	Silver	$153.02	Go to Site
	Hospital Silver Plus	Silver	$153.35	Go to Site
	Premium Hospital Non Obstetrics	Silver	$165.40

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

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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