The average public hospital waiting time was 203 days during the period we looked at.
You can get covered with private health insurance for around $161 a month.
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.
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.
Depending on your age, you may be eligible for an
aged-based discount. This is used to estimate your
rebate.
Under 65
65 - 69
70 or older
What's your household's taxable income?
This is the combined income you and your spouse earn before tax. It's needed to calculate the correct Australian government rebate.
$93,000 and under
$93,001 to $108,000
$108,001 to $144,000
$144,001 and over
What kind of health insurance do you need?
Combined (Extras + Hospitals)
Extras
Hospital
What level of hospital coverage would you like?
You can change this at any time later.
Legend
Covered
Restricted cover, You may be partially covered for
this category.
Not covered. Optional for insurer to include.
*Prices updated March 2024, in line with Finder's
database of health insurance policies. Prices are based
on a single individual with less than $93,000 income and
living in Sydney with a $750 excess.
What extras cover do you need? (Optional)
Select as many as you want or move to the next step
Preventative & general dental
Major dental & implants
Optical
Physiotherapy
Podiatry
Non-PBS pharmaceuticals
Chiropractic
Emergency ambulance
Remedial massage
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Comparing quotes from 30+ funds...
Finder survey: How many Australians in different states made a hospital claim for any of these conditions?
Response
WA
VIC
SA
QLD
NSW
Bone joint and muscle
1.89%
2.59%
1.33%
6.09%
3.19%
Source: Finder survey by Pure Profile of 1006 Australians, December 2023 Data for ACT, NT, TAS not shown due to insufficient sample size. Some other states may also be excluded for this reason.
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.
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
Why you can trust Finder's health insurance experts
You pay nothing. Finder is free to use. And you pay the same as going direct. No markups, no hidden fees.
You save time. We spend 100s of hours researching health insurance so you can sort the gold from the junk faster.
You can trust us. We say it like it is. We aren't owned by an insurer and our opinions are our own.
FAQs about knee surgery
Medicare can cover the entire costs of a total knee replacement. However, you won't be able to choose your doctor, hospital or time of 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.
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.
Gary Ross Hunter was an editor at Finder, specialising in insurance. He’s been writing about life, travel, home, car, pet and health insurance for over 6 years and regularly appears as an insurance expert in publications including The Sydney Morning Herald, The Guardian and news.com.au. Gary holds a Kaplan Tier 2 General Advice General Insurance certification which meets the requirements of ASIC Regulatory Guide 146 (RG146). See full bio
Gary Ross's expertise
Gary Ross has written 729 Finder guides across topics including:
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You pay nothing. Finder is free to use. And you pay the same as going direct. No markups, no hidden fees.
You save time. We spend 100s of hours researching health insurance so you can sort the gold from the junk faster.
You can trust us. We say it like it is. We aren't owned by an insurer and our opinions are our own.
