Private Health Insurance For Knee Replacements

What to know about knee replacement surgery in Australia

As we get older, our joints start to show signs of wear and tear. One in 11 Australians^ will require knee replacement surgery now or in the future. Here’s what you need to know about the cost of this procedure.

One of the areas that can cause significant pain as we age, and reduce mobility, is our knees. With a 38%^ rise in Australians requiring knee replacements, this procedure is becoming more common. 

Should your specialist recommend knee replacement surgery for you, here’s what you need to know:

What is a knee replacement?

A knee replacement is when part of your knee (partial replacement) or all of it (total replacement) is removed and replaced with a prosthetic knee made from metal and plastic.

Total knee replacements are much more common. They’re carried out when your whole knee, or the majority of it, is damaged.

A partial knee replacement may be required if only a part of your knee is worn down, damaged, or diseased, but the rest of your joint is still functional.

What’s the difference between knee reconstructions and knee replacements?

Both knee reconstructions and knee replacements involve surgery.

Knee reconstruction surgery reconstructs, or ‘fixes’, the part of the knee that is damaged. Knee replacement surgery swaps out the whole knee for a prosthetic one.

Though you'll usually recover much faster from reconstruction surgery than knee replacement surgery, it’s not necessarily a permanent solution.

If your knee sustains further damage, you may end up needing a knee replacement procedure anyway. Your doctor will advise you on which type of surgery you require.

How long does a knee replacement last?

How long your knee replacement lasts depends on the type of surgery you have. An artificial joint doesn’t always mean it’ll last you for the rest of your life.

According to a recent study by the National Institute of Health in the UK, which analysed surgical data from several countries including Australia, 82% of total knee replacements were still intact after 25 years. 

The figures for partial knee replacements are similar: 70% of patients were still going strong at the 25-year mark. 

How much does a knee replacement cost in the public system in Australia?

Knee replacement surgeries are covered by Medicare in the public hospital system. However the waiting lists for this and other orthopaedic surgeries are over 2 years in some cases.

How does private health insurance cover knee surgery?

The right private health insurance can cover the majority of your knee surgery costs, though you may still have some out-of-pocket expenses.

Knee reconstructions and replacements are covered in Silver, Silver Plus and Gold level cover.

The good news is that because private health insurance gives you the freedom to choose which surgeon you see, you'll be in a much better position to keep those extra costs as low as possible and skip the public hospital waiting lists. You can also elect to be admitted to a private hospital.

Will my choice of health insurer affect my out-of-pocket costs?

Different health insurers offer different types of cover for knee surgeries. Some may leave you with more out-of-pocket expenses than others. 

For example, HCF is one of the health insurers we compare. This fund estimates a knee replacement costs around $28,242#.

That said, if you visit a participating private hospital, have no excess and find a doctor that has a no-gap arrangement with HCF or another fund of your choice, you can really cut your out of pocket costs to around $1,005, based on HCF’s own information. 

Other funds may have similar arrangements. Ask our experts at Compare Club about health funds which have arrangements with your local hospital.

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How much does a knee replacement cost out of pocket?

According to a report from the Royal Australasian College of Surgeons published in conjunction with Medibank, the out of pocket expenses for this type of procedure depend on your surgeon. 

From the 543 surgeons who were interviewed, 192 did not charge their patients any out of pocket fees whereas others charged up to $5,137, with a median price of $162.

A patient with an appropriate level of hospital cover may find their expenses are no more than a couple of hundred dollars. 

Which tiers of health insurance cover knee replacements?

Most health funds offer cover for knee replacements on their Gold tier plans, though older Australians can get the appropriate cover on a Silver plan, too.

All health insurers on our panel offer joint replacements on their top-end Silver and Gold tier plans. Our Compare Club experts can help you find the coverage that’s right for you.

How to get knee reconstructions covered on your policy:

Speak to your health insurance provider to see if they cover this type of surgery. If they don’t, it might be time to shop around. Be aware that you may have to serve a minimum waiting period after moving to a cover with new inclusions.

What are the waiting periods for claiming on knee replacement surgery costs?

As with most surgical procedures, you’ll need to serve a waiting period before you can claim knee surgery (unless you’re switching from an equivalent hospital cover that you’ve held for more than 12 months). 

If you take out a policy when you already need the surgery, it's classed as a pre-existing condition. In this case, a 12-month waiting period may apply before you can lodge a claim.

If your condition developed after the policy has been taken out, your waiting period may only be two months. 

That said, some insurers are willing to reduce or waive some waiting periods. Compare Club can help with this.

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What are the standard public hospital waiting times for knee replacements?

According to the latest available data from the Australian Institute of Health and Welfare, orthopaedic surgeries under the public system have some of the longest waiting times of any surgery. The median waiting time is around 209 days.

18 months of lockdowns in some states has meant the public waiting list for elective surgeries, such as knee replacements, keeps growing.

The right private health insurance can help ease the financial pressure of joint replacement surgery – so you can get back to living your life. 

If your current provider doesn’t offer the kind of knee replacement surgery cover you need, speak to our Compare Club specialists today. 

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 hip injury, private health insurance can cover your hip replacement surgery.

Sources: 

^Australian Institute of Health and Welfare, Osteoarthritis, accessed 18th January 2021.

^^MBS Online, Medicare Benefits Schedule - Item 49518, accessed 18th January 2021.

#HCF, Procedure cost indicator knee replacement, accessed 20th January 2022.

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Chris Stanley is the sales & operations manager of health insurance at Compare Club. With extensive experience and expertise, Chris is a trusted leader known for his deep understanding of health insurance markets, policies, and coverage options. As the sales & operations manager of health insurance, Chris leads a team of dedicated professionals committed to helping individuals and families make informed decisions about their health insurance needs.

Meet our health insurance expert, Chris Stanley

Chris's top health insurance tips

• 1

  Australia’s public health system is world-class, but wait times for public hospitals can be long, inconvenient - and leave you living in constant pain while you wait.

• 2

  An appropriate private health insurance policy can speed up your surgery, relieving your pain sooner.

• 3

  Family health cover means your children are covered under the same policy as you.

• 4

  Many health insurance policies come with a 12-month waiting period for pregnancy-related cover, so it’s a good idea to get a family policy organized well before starting your family. This means your child will be covered from birth until at least their early twenties (depending on which health fund you select).