Health insurance for hip replacement surgery

Whether due to osteoarthritis, an accident, or general wear and tear, hip replacements are one of the most common elective surgeries in Australia - but if you need one, how much will you have to pay?

The cost of a hip replacement can be steep. The good news is it can be covered by both Medicare and private health insurance. Here’s what you need to know.

What is a hip replacement?

A hip replacement, also known as hip arthroplasty, is a type of surgery for replacing the damaged bone and cartilage (the tissue at the end of the bone that cushions the joint) in your hip.

These damaged areas are replaced with parts made of either metal, ceramic or plastic. The replacement parts are specially designed to mimic the natural function of the hip joint.

There are two types of hip replacement:

• Partial hip replacement: the ball on the end of the thigh bone is replaced with a ceramic or metal ball, and attached to the bone.

• Total hip replacement: the ball of the hip and the socket of the hip joint are both replaced.

A hip replacement can also be done on one hip (single) or both hips (bilateral).

Some signs you might need a hip replacement include:

Your doctor might recommend a total hip replacement if you have serious hip damage that’s interfering with your life and other treatments aren’t helping. For example, a hip replacement could be the next step if:

• You have pain that isn’t helped by medication.

• Your hip is making it difficult for you to walk, move or otherwise be active.

• Pain is significantly affecting your sleep and daily life.

• You haven’t seen any improvement with other treatments like physical therapy.

What does hip replacement surgery involve?

The surgery itself usually takes an hour or two. You’ll either be given a general anaesthetic, which makes you fully unconscious, or a spinal anaesthetic, which numbs the lower half of your body.

After the surgery you’ll probably spend a few days in hospital. Your doctor or care team will help you start walking with a support and give you guidance on how to take care of your new hip.

Full recovery from hip replacement surgery usually takes around three months but can be up to 12 months. During the first few months of recovery, you’ll need to avoid activities like running, squatting and jumping. You’ll also need to do rehabilitation, like physio and occupational therapy, to strengthen your hip.

In most cases, once you’re fully recovered you should be able to resume your normal activities and low-impact sports like golfing, swimming, cycling and walking.

How much does a hip replacement cost without private health insurance?

The cost of a hip replacement varies a lot depending on the complexity of the surgery, who’s treating you, and whether you’re a public or private hospital patient.

The Medicare Benefits Schedule (MBS) lists several hip replacement surgeries, with MBS fees ranging from $1,371.25 to $2,409.15.

If you’re treated in a public hospital as a public patient, Medicare covers the full cost of treatment. However, public hospital waiting lists for orthopaedic surgery, like hip replacements are long… very long.

Waits of upwards of a year are not uncommon. You can find out more about waiting periods here.

If you’re treated in a private hospital, Medicare pays 75% of the fee listed in the MBS. Your health fund may cover some or all of the difference, depending on your level of cover, as well as theatre fees, accommodation costs etc.

According to the Australian Government’s Medical Costs Finder, in 2019-20, 19% of private patients paid nothing for hip replacement surgery. For everyone else, the average out-of-pocket cost was $560.

Which state is the cheapest for hip replacement surgery?

According to 2019-20 data from the Australian Government, the cost of hip replacement surgery is cheapest in Western Australia. The typical doctors’ fees for hip replacements in WA are $4,100, with patients paying an average out-of-pocket cost of $170.

Here’s a state-by-state breakdown of typical costs:

Does Medicare cover hip replacement surgery?

Medicare will typically cover the cost of hip replacement surgery when you’re a public (Medicare) patient in a public hospital if your doctor indicates there’s an essential medical reason for it.

As a public patient you won’t be able to choose your hospital and surgeon.

On top of that, average wait times for public patients in public hospitals are typically a lot longer than wait times for private hospital patients.

According to data from the Australian Institute of Health and Welfare, public patients wait an average of 125 days for hip replacement surgery, while private patients wait an average of 53 days.

That’s a big difference, especially if you’re living with life-limiting pain.

How much does private health insurance for hip replacement cost?

Joint replacements usually sit in with Gold tier health cover. However, it’s possible to get hip replacements procedures included in some Silver Plus Hospital policies. This could bring your costs down to around $165-200 per month**.

Does private health insurance cover hip replacements?

Yes, most health funds offer cover for hip replacements as part of their medium or top-tier hospital cover.

If you choose to go private, you’ll most likely have more of a say about your hospital and doctors. You could also have a much shorter wait time for surgery.

Keep in mind though that different health funds offer different excesses, cover limits and maximum payable benefits towards hip replacement surgery. This means the amount you’ll need to pay out of pocket (if anything) will depend on your surgeon’s fees, your health fund and your policy.

What are the waiting periods for hip replacement surgery?

Most health funds have a 12-month waiting period for hip replacement surgery as it’s usually a pre-existing condition.

In other words, you’ll need to be covered for at least 12 months before you can claim a benefit payment for a hip replacement.

However, waiting periods are usually waived if you switch from one policy to an equivalent policy and you’ve already served your waiting periods on the original policy.

So if you think you might need surgery on your hip at some point, it’s a good idea to check your health cover. You could find that an alternative fund offers better value for money, and you might be able to make a claim straight away.

How do I find the best private health insurance for hip replacements?

Speak to an expert. Our health insurance specialists can help you find a great value cover suited to your needs from a panel of trusted funds#. We saved Aussies an average of $300* when they compared and switched with us.

What other major surgeries are covered by tiers of private health insurance?

Private health insurance can cover a wide range of treatments depending on the level of cover you choose. As an example, if you have a severe knee injury, private health insurance can cover your knee replacement surgery.

This guide is opinion only and should not be taken as medical or financial advice. Check with a financial professional before making any decisions. *Based on 136,746 customers between 1 Jan 2018-23 December 2022. ** HIF Silver Plus Hospital policy covers joint replacements and is available from $162.43/month as of February 2023. #Compare Club compares selected products from a panel of trusted insurers. We do not compare all products in the market.