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Health insurance for hip replacement surgery

This guide explains what Medicare and private health insurance will cover with hip replacements.

If your doctor has recommended you get a hip replacement, it's worth considering the options Medicare and private health insurance provide to see how they can help reduce the cost of treatment.

When might you need hip replacement surgery?

Hip replacement is usually recommended after other treatments like physical therapy, exercise and medication have failed to improve your condition. You may need a hip replacement if:

  • Your pain isn't improved by medication
  • Your hip has become weak and unstable
  • Pain stops or limits you from getting out and being as active as normal
  • Pain affects your sleep

How does Medicare cover hip replacement surgery?

Medicare covers most medically necessary surgeries like hip replacements. Public patients should have no out-of-pocket expenses for surgery in a public hospital. Additionally, Medicare pays 75% of the Medicare Benefits Schedule (MBS) to private patients in public hospitals, meaning it will cover 75% of the public rate for the surgery, anaesthesia and diagnostic work.

While Medicare provides hip replacements with little or no out-of-pocket expenses for public patients in public hospitals, you may have to wait several months before receiving surgery. It's also worth remembering that you won't be able to choose your doctor if using the public system.

How to claim the Medicare rebate

You can claim your Medicare benefit using your Medicare online account accessible through myGov or your doctor. Because hip replacements can be so expensive, with prices varying from $19,439 to $42,007 depending on the surgeon, it's essential that you do this in order to avoid a substantial bill.

Average public vs private wait times in Australia for hip replacement surgery

Source: Australian Institute of Health and Welfare (AIHW) Private health insurance use in Australian hospitals 2006–07 to 2016–17

How does private health insurance cover hip replacement surgery?

If you go private, you'll have your choice of surgeon and hospital. There's a good chance you'll also have more say over when the surgery takes place.

To be covered, you'd need a private hospital policy, normally medium to high level. If you're getting joint replacement cover for the first time you'll also have to serve a waiting period of 12 months.

For the treatment, you're likely to receive out-of-pocket costs depending on things like your excess and what your doctor charges. That's why it's important to do your research beforehand.

What do different insurers offer for hip replacement surgery?

Below are some examples from Finder that cover joint replacement surgery. All quotes are based on a single hospital policy in Sydney, NSW.

Picture: Unsplash

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