The total cost of knee replacement surgery will depend on the type of surgery you need, the doctors who treat you and whether you’re treated privately or through the public system. Your knee surgery costs may differ from the figures below.
According to the government’s Medical Costs Finder, the typical specialist fee for a total knee replacement as a private patient is $5,200 (based on MBS item number 49518). 5 The insurer typically pays $1,800 of this amount while Medicare pays $1,900. However, this is only the amount charged by your doctors (e.g. orthopaedic surgeon and anaesthetist) and does not include any other hospital costs.
The typical hospital fees when admitted to a private hospital for a total knee replacement can add up to around $18,000. 5 This can include accommodation, theatre fees, medical devices and more.
However, when you’re covered by an appropriate hospital insurance policy, Medicare together with your health fund will pay 100% of the Medicare Benefits Schedule (MBS) fee – the cost deemed reasonable by the government – for your specialists, while your health fund will also pay some or all of the hospital costs.5 Because of this, the average cost paid by patients for a knee replacement in a private hospital is only $1,000 (not including excess or co-payments).
While you may still have some out-of-pocket costs (the difference between your actual specialist fees and the MBS fee), you may be able to avoid them or pay less if you participate in your private health insurance company’s gap cover scheme (if available).
Knee replacement is a major surgery and costs can vary based on factors such as the patient’s other health conditions and the complexity of the surgery. For more details about your surgery and any out-of-pocket expenses, you should have a discussion with your surgeon and your health fund before the operation. They’ll know the specifics of your surgery and will be able to offer a more accurate quote.