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If you’re experiencing frequent knee pain and decreased mobility, you might be considering treatment to regain your quality of life; knee replacement surgery could do just that. We’ll take you through how a knee replacement works and what it could cost you.
Our health insurance expert, Steven Spicer, has put together some great tips on how to find the right health insurance for your knee replacement.
Many of those who undergo knee replacement surgery experience less pain and greater mobility. However, it may not be recommended for everyone. It’s important to have a discussion with a medical professional about your situation so they can outline the potential risks and benefits of knee replacement surgery for you.
While joint replacement surgery is considered a minimum requirement of the more expensive Gold product tier, there are many health funds that offer coverage for it on Silver Plus policies, which often come at a lower premium.
Is it likely you will need knee surgery in the near future? Whilst you might pay a bit more for the premiums now, it may be best to look at policies with a lower excess. It could save you money in the long run and you can always increase it in the future.
It’s important to regularly review your health insurance policy to ensure it meets your needs. If you currently do not have cover for joint replacements but think you may need a knee replacement in the coming years, it might be a good idea to upgrade your policy early with a plan to serve the relevant waiting periods before you need surgery.
Knee replacement surgery is a medical operation that helps repair joints by replacing damaged parts with prosthetic components usually made from metal or plastic. This surgical procedure typically takes around one to two hours and is usually done to help alleviate chronic knee pain.
There are several types of knee replacements depending on the type and severity of your injury. A few of the most common procedures are:
You may consider knee replacement surgery when pain is ongoing and affects your mobility. It could help alleviate the following ailments:
The 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.
According to the government’s Medical Costs Finder, the typical specialist fee for a total knee replacement as a private patient is $4,800 (based on MBS item number 49518).1 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 $18,000.1 This can include accommodation, theatre fees, medical devices and more.
However, when you’re covered by an appropriate hospital insurance policy, Medicare and 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. Because of this, the average cost paid by patients for a knee replacement in a private hospital is only $680 (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).
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.
If you don’t have an eligible hospital cover, Medicare will cover the entire costs of your total knee replacement as a public patient in a public hospital. However, you won’t be able to choose your doctor, hospital or time of surgery.
Knee replacements are generally considered elective surgery, which means you’d have to go on a waiting list if you sought treatment through the public healthcare system. According to the Australian Institute of Health and Welfare (AIHW), around half of people on the waiting list for a total knee replacement waited 255 days for their surgery in 2020-21, while 26% waited more than a year.2
So, if you’re looking to avoid the public waiting list and get back to healthy living faster, you should consider taking out an appropriate level of hospital cover.
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.
1 Australian Government Department of Health. Medical cost finder. Accessed May 2022.
2 Australian Institute of Health and Welfare. Elective surgery waiting times 2020-21: Australian hospital statistics. Accessed May 2022.