Health insurance for knee surgery

Knee surgery can stop unrelieved pain and increase your mobility, but wait times can be significant in the public system. Private health insurance can help you get treated sooner than under Medicare - compare your options below.

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What is the cost of knee surgery/replacement?

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.

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.

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.

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

Name Product Joint replacements Joint reconstructions Price Per Month Hide CompareBox Apply
ahm deluxe silver plus
$160.20
Qantas Silver Plus Hospital
$159.84
HBF Gold Hospital
$169.48
Peoplecare Silver Plus Hospital
$177
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Quotes are based on less than $90,000 income with $500 excess.

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.

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 vs private waiting list for knee surgery

The average waiting lists for knee surgery vary between the public and private health system. Average wait times for knee surgery in the public system can be up to 203 days, while private wait times are closer to 76 days.
hospital waiting days

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

When might you need knee surgery?

If your doctor has recommended knee surgery, it's likely you've tried everything else to alleviate the pain. A bad knee can affect your every move, and pain can be excruciating even while lying down. You may 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

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:

This is a minimally invasive surgical procedure that allows doctors to view the knee joint without making a large incision. Arthroscopy is used to diagnose and treat a range of knee problems.

The meniscus repair is a more significant surgery but has a better long-term prognosis when compared to other forms of surgery. However, recovery is longer and surgery is not always possible depending on the patient's health.

The anterior cruciate ligament is one of the four major knee ligaments and the key to knee stability. An ACL is a common sports injury and usually requires surgery since it is such a vital ligament.

The bone and cartilage on the end of the thigh bone (femur) and top of the shin bone (tibia) are removed. A metal and plastic knee replacement implant are put in place and function as the new knee joint. The kneecap surface may also be replaced depending on the condition of the cartilage underneath the kneecap.

Surgery involves the removal of a portion of the meniscus cartilage from the knee joint. The meniscus provides cushioning and support between the bone ends.

Surgery addresses areas of cartilage damage that are inside the knee joint. The procedure creates a healing response so that new cartilage is formed where there was once a gap.

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.

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