Health insurance for knee surgery

If your doctor has recommended knee surgery, it's likely you've tried everything else to alleviate the pain. Without insurance, the procedure can be very expensive in Australia. So make sure your decision isn't affected by the cost; having the right insurance will allow you to get the surgery you need and improve your quality of life.

When might you need knee surgery?

A bad knee can affect your every move, and pain can be excruciating even while lying down. It’s likely you need surgery when other treatments – like exercise and medication – have failed to alleviate the pain or increase your mobility. You probably need knee replacement surgery if:

• Medication is not improving pain, including injections into the knee
• Weight loss and exercise haven’t stopped the pain
• Your knee has become weaker
• Your quality of life is worsened by your inability to move around

How does Medicare cover knee surgery?

With Medicare, there are little out-of-pocket expenses for knee replacement surgery if you are a registered public patient and have surgery in a public hospital. However, people wait for months to receive surgery, which could worsen your condition and health as it prolongs the period you're forced to live with chronic pain and poor mobility.

You are also unable to choose your own doctor, or the amount and time of consultations you have prior to your operation under Medicare.

How to claim the Medicare rebate

You can claim your Medicare rebate using your Medicare online account. This can be accessed through myGov or by speaking to your doctor. It's vital you do this, as surgery is expensive. Whilst Medicare will cover 75% of costs, there can still be out-of-pocket expenses, so do your research beforehand.

Public waiting list for knee 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 knee surgery?

If you decide to get private health insurance, there will be some out-of-pocket expenses for knee surgery. However, the amount really depends on your excess, as well as things like the hospital and doctor you use. One of the perks of going private is that you get to decide where you have the surgery and your surgeon, so you have more control over expenses.

What do different insurers offer for knee surgery?

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

Provider	Policy	Treatment	Price per month	Apply
	Deluxe Silver Plus	Hospital treatment for surgery for joint replacements, including revisions, resurfacing, partial replacements and removal of prostheses.	$144.75	Go to Site
	Silver Plus Hospital	Replacement of shoulder, wrist, finger, hip, knee, ankle, or toe joint, spinal disc replacement.	$145.64	Go to Site
	Core Hospital (Silver+)	Replacement of shoulder, wrist, finger, hip, knee, ankle, or toe joint, spinal disc replacement.	$146.91	Go to Site
	Silver Advantage Hospital Plus	Hospital treatment for surgery for joint replacements, including revisions, resurfacing, partial replacements and removal of prostheses. Replacement of shoulder, wrist, finger, hip, knee, ankle, or toe joint, spinal disc replacement.	$147.04	Go to Site
	Silver Advantage Hospital Plus	Hospital treatment for surgery for joint replacements, including revisions, resurfacing, partial replacements and removal of prostheses. Replacement of shoulder, wrist, finger, hip, knee, ankle, or toe joint, spinal disc replacement.	$147.04	Go to Site
	Silver Plus Security	Hospital treatment for surgery for joint replacements, including revisions, resurfacing, partial replacements and removal of prostheses. Replacement of shoulder, wrist, finger, hip, knee, ankle, or toe joint.	$147.30	Go to Site
	Silver Advantage Hospital Plus	Replacement of shoulder, wrist, finger, hip, knee, ankle, or toe joint, spinal disc replacement.	$153.02	Go to Site
	Hospital Silver Plus	Replacement of shoulder, wrist, finger, hip, knee, ankle, or toe joint, spinal disc replacement	$153.35	Go to Site
	Premium Hospital (Gold)	Replacement of shoulder, wrist, finger, hip, knee, ankle, or toe joint, spinal disc replacement.	$176.73

Quotes are based on less than $90,000 income with $500 excess.

What is the cost of knee surgery?

For a knee replacement, the average cost can range from $17,00 to $30,000, whilst a knee cruciate ligament repair can cost between $5,000 and $14,000 so it's worth shopping around for the most affordable option.

How to work out your own estimate

It's important that you confirm the costs ahead of time, as there can be up to $5,000 in out-of-pocket expenses if you don't do your research. There are a number of things you can do to work out the total cost:

• Call your surgeon to get a cost estimate.
• Find out if your surgeon is in your private health insurer's preferred list.
• Get an estimate on extras and make sure there are no out-of-pocket expenses; extras can include paying for X-rays and an anaesthetist.
• Get a Medicare code. Call your private health insurer and give them your code.
• Find out your doctor's estimated rebate.

What are the types of knee surgery?

The type of surgery you will receive depends on the problem you are having with your knee. There are four main types of knee replacement surgery: total knee replacement, partial knee replacement, kneecap replacement and complex knee replacement. There are several procedures, the most common of which are:

• Arthroscopic surgery
• Meniscus repair
• ACL surgery
• Knee replacement surgery
• Meniscectomy
• Microfracture

How long is the recovery time?

Because there are various kinds of knee surgery, recovery depends on the severity of your problem and the type of surgery you have.

Nevertheless, most people are able to walk independently after 1-2 weeks, though this varies depending on the individual.

You should be able to stop using your walking aid and resume normal activities around six weeks after surgery. However, it can take up to three months for pain and swelling to go down and a year for any swelling to completely disappear.

Your new knee will continue to recover up to two years after your operation. During this time, the muscles around the knee will begin to strengthen themselves as you move around.

Explore your private options for knee surgery

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