Your hips and knees are some of the largest joints in your body working to help you stand, keeping you balanced and taking you on bushwalks. If knee or hip pain is stopping you from doing the things you love, health insurance can help pay benefits towards getting you back on your feet again and regaining your active lifestyle.
If your doctor has recommended joint replacement surgery, it can feel like a huge step. But knee replacements and hip replacements are common elective surgeries in Australia. Joint replacement surgery, where a damaged joint is replaced with an artificial one, is more common after the age of 65, especially if you have osteoarthritis.
Unfortunately, waiting lists for hip and knee replacements at public hospitals can be lengthy. In 2023–24, the average wait for a total knee replacement in Australia was more than eight months, and almost five months’ wait for a total hip replacement, according to the AIHW. That’s a long time to be in pain.
That’s where health insurance can be life-changing. If you’ve got hospital cover that includes joint replacements, you could be treated in a private hospital faster, helping you get back to enjoying your life sooner.
Does private health insurance cover joint replacements?
It depends. The private health insurance benefits you receive depend on your insurer and level of cover. You’ll need to have hospital cover that pays benefits towards joint replacements – most insurers, including Medibank, provide this level of cover on Silver Plus or Gold policies. Make sure you look closely at the wording – cover for ‘joint reconstruction’ does not provide benefits for joint replacement surgery.
If you’ve recently taken out your policy or upgraded your level of cover, there might be a waiting period before you can claim, especially if you have a pre-existing condition such as arthritis.
How much does a joint replacement cost?
The cost of a knee replacement or hip replacement depends on the doctor and hospital. While Medicare and your insurer will cover the Medicare Benefits Schedule fee amount, you’ll have to pay any doctors’ fees that exceed this. As a rough guide, in 2022–23 doctors charged average fees of $4,900 for a knee replacement, leaving patients with an average gap of $880, not including hospital fees.
For a hip replacement, fees for doctors and specialists came to around $5,200 in 2022–23, with an average gap of $1,000, excluding hospital costs. Hospital fees are typically $19,000 for this procedure, including accommodation, the operating theatre or medical devices; thankfully private health insurance generally pays benefits for most of this, depending on your level of insurance and the hospital you choose. Hospital fees may apply to private patients in a public or private hospital.
In good news for your pocket, if you’re a Medibank member eligible for the No Gap Joint Replacement Program, you’ll pay no out-of-pocket costs* on a wide range of services for elective surgeries including knee and hip replacements, provided you use a participating doctor and hospital.
What’s covered in joint replacement surgery?
Hospital cover for this procedure applies to joints including the knee, hip, shoulder, wrist, ankle, finger or toe joints. The right level of hospital cover will contribute to your hospital stay, most hospital costs, and most of the fees of your surgeon and other doctors (such as anaesthetists).
Specialist appointments and scans in the lead up to your surgery will not be covered by private health insurance, as outlined by Australian law.
After joint replacement surgery, you’ll need rehabilitation for a few weeks or even months. Rehab will start in the hospital, and your private health insurance may pay benefits towards this, depending on your level of hospital cover. Your Extras cover will subsidise your costs for out-of-hospital services such as physiotherapy, or if you’re an eligible Medibank member, you can take advantage of the Rehab at Home program for physio and nursing. Find out more.
Does Medibank cover joint replacement?
Yes. Both Silver Plus Secure and Gold hospital cover policies from Medibank pay benefits towards joint replacement surgery, and our Rehab at Home program will make your recovery smoother. The amount Medibank pays will depend on your policy, the hospital you choose as well as your excess, waiting periods and other conditions.
If you’re eligible for Medibank’s No Gap Joint Replacement Program, you’ll pay no out-of-pocket costs on knee and hip replacements.*
Interested?
Call out friendly team on 132 331 to find out if you're eligible or get a quote for Medibank hospital cover that includes joint replacement surgery.
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Things you need to know
* There may be out-of-pocket expenses associated with outpatient appointments, such as your initial visit with a participating surgeon in their consulting rooms. An excess or per day payment may still be payable, depending on the product a member has chosen and whether they are claiming under their hospital cover for the first time in a calendar year.