ACL surgery cost
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Expert tips for finding health insurance
Our health insurance expert, Steven Spicer, has some helpful tips for comparing health insurance policies.
Steven Spicer
Executive General Manager – Health, Life & Energy
Choose the right level of cover
Deciding the right level of cover for your needs is one of the critical parts of choosing a private health insurance policy. While some people want the peace of mind that comes with a comprehensive policy, this might not be practical for those on a budget. The right level of cover will have the inclusions you need without having to pay for cover you’ll never use.
Keep waiting periods in mind
If you’re purchasing health insurance for the first time or switching policies, you may have to serve waiting periods before you can make a claim. To avoid missing out on cover, consider your health needs and family history to purchase a policy that will provide the necessary cover you’ll likely need in the future.
Save money by getting health insurance while you’re young
Being young, healthy and active doesn’t mean you won’t benefit from health insurance. Along with providing cover for unforeseen injuries (like an ACL tear), purchasing and maintaining hospital cover before July 1st, after you turn 31, will help you avoid the Life Health Cover (LHC) loading. Many insurers even offer age-based discounts of 2% on your private hospital cover for every year you’re under 30 (up to a maximum of 10%).
What is anterior cruciate ligament reconstruction?
An anterior cruciate ligament (ACL) reconstruction is a surgical procedure that repairs damaged ligaments in your knee.1 The ACL is a crucial ligament in your knee that, when ruptured, can lead to your knee collapsing or giving way. Though there are a few ways you can get a torn ACL or similar ACL injury, accidents during sporting activities are one of the more common causes. Depending on the injury, you may also experience damage to the knee joint surface and the cartilage (meniscus).
ACL repair is usually performed through arthroscopy (keyhole surgery) rather than open surgery and is done by an orthopaedic surgeon.1
Why would I need ACL surgery?
Not all ACL injuries require surgery, with roughly 4 in 5 people (who aren’t elite athletes) able to recover on their own or with the help of physical therapy.1 However, for serious knee injuries, ACL surgery can help prevent the knee from collapsing. Avoiding ACL surgery when needed could worsen the problem, potentially meaning more expensive treatment and a longer recovery. A successful ACL surgery can stop your knee giving way and help you live a more active and healthy life.
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How much does ACL surgery cost in Australia?
Knee reconstruction (repairing or rebuilding ligaments in the knee) will have a typical specialist fee of $4,100 (based on Medicare Benefits Schedule item number 49542).2 Medicare will cover $1,500 of this cost and private health funds typically pay $1,400. The median out-of-pocket cost for patients is about $940. Hospital fees, covering your hospital stay, theatre fees, and medical devices, will typically be around $5,300 for this procedure.
It’s important to remember these prices are a rough guide and that your surgery could exceed them. Some of the key factors that will influence your overall ligament surgery costs include:
- Your choice of specialist
- The complexity of your procedure
- Severity of the ACL tear
- Where in Australia you’re having the procedure performed
- The length of your hospital stay
- Whether your surgery is just fixing your ACL or dealing with multiple knee issues (such as a meniscal repair or bone damage).
Does private health insurance cover ACL reconstruction surgery?
Yes, health insurance can cover ACL reconstruction procedures, providing you have the right level of private hospital cover. Your policy will need to include the joint reconstruction clinical category and the bone, muscle and joint clinical category for you to receive cover. This category is a minimum requirement for Bronze tier policies and up.
Being treated as a private patient comes with benefits including:
- Avoiding the public hospital waiting list
- Choice of private healthcare facility and specialist (depending on availability and urgency of procedure)
- Private room (subject to availability).
A ‘gap’ may exist between the MBS fee and your specialist fees, which may mean more out-of-pocket costs. Your health fund may cover none, some or all of these costs, depending on your policy, the hospital you are admitted to, and any treating doctors.
If you’re purchasing health insurance for the first time or are upgrading your policy, you may need to serve a waiting period before you make a claim on your hospital policy. For most pre-existing conditions (excluding rehabilitation, in hospital psychiatric treatment and palliative care) or pregnancy and birth related services, this waiting period will be 12 months; otherwise, it will usually be 2 months.
Is ACL surgery covered by Medicare?
If your ACL surgery is performed in a public hospital, the procedure will be covered by Medicare. If you have your procedure performed in a private hospital, some of your MBS fee will be covered by Medicare, while the rest will need to be paid by you or your health fund, depending on whether you have cover and if there is an out of pocket cost.
While the public health system is a valuable service, there is often a waiting list. Depending on your procedure, you could wait months for treatment of your ACL injury in a public hospital.
Meet our health insurance expert, Steven Spicer
As the Executive General Manager of Health, Life and Energy, Steven Spicer is a strong believer in the benefits of private cover and knows just how valuable the peace of mind that comes with cover can be. He is passionate about demystifying the health insurance industry and advocates for the benefits of comparison when it comes to saving money on your premiums.
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1 Health direct ‒ ACL reconstruction. Accessed November 2024.
2 Medical Costs Finder ‒ Knee reconstruction. Accessed November 2024.