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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!

So, let’s have a look at what this procedure entails and how much it may cost. We’ll also break down whether Medicare and private health insurance provide any financial assistance to help you get moving again.

What is knee replacement surgery, and how does it work?

Knee replacement surgery is a medical operation that helps repair joints by replacing damaged parts with prosthetic components made from metal or plastic. This surgery typically takes around one to two hours and is usually done to help alleviate chronic knee pain.

Types of knee replacement surgery

  • Total knee replacement surgery. Involves a total replacement of ligaments and joints from the thigh bone (or femur) to the connecting part of your shin (or tibia);
  • Revision knee replacement. Also known as complex knee replacement surgery, revision knee replacements are required when an existing prosthesis is worn out and needs to be swapped with a new one;
  • Partial knee replacement. Is where your knee might have damaged ligaments that need replacing, while conserving others that might still be in good condition.
  • Kneecap replacement. Unlike total knee replacement surgery, only the kneecap (or patella) is replaced with a metal or plastic prosthetic.

When would I need knee replacement surgery?

You may consider knee replacement surgery when pain is ongoing and affects your mobility. It could help alleviate the following ailments:

  • Osteoarthritis. Common among older Australians, osteoarthritis is a condition where cartilage gradually wears down over time;
  • Rheumatoid arthritis. An autoimmune disease where the body struggles to fight off infection, resulting in swelling of the joints;
  • Haemophilia. A disorder where blood fails to clot. In some cases, the blood that isn’t clotted can fill knee joints and cause damage;
  • Skeletal dysplasia. A genetic disorder that affects the development of bone and cartilage; and
  • Avascular necrosis. When bone tissue dies off from a lack of blood supply.

How much does a knee replacement cost in Australia?

Knee replacement costs will depend on the type of surgery you need. According to the Medicare Benefits Schedule (MBS), total knee replacement costs start from $1,371.25 without any rebate from Medicare (based on MBS item 49518).1 However, more complex procedures may have higher costs.

What is the MBS?

The MBS is a list of all medical services in Australia that are eligible for a government rebate. Australians with hospital cover can claim up to 75% of the services on the MBS, while their health fund will cover the remaining 25%.

Knee surgery costs

 

MBS item numberSurgery typeMBS FeeMedicare covers 75%Remaining 25%
49518Total knee replacement$1,371.25$1,028.45$342.80

Based on the October 2021 Medicare Benefits Schedule

It’s important to note that these are the scheduled fees and they don’t include any additional charges that might be included by your selected surgeon and hospital. In fact, depending on which state or territory you live in, doctors may charge anywhere between $3,800 and $6,800 for knee replacement surgery.2 Additionally, doctors and specialists can set their own fees, which means there may be a gap payment to cover the difference between what doctors charge and what Medicare and private health insurance covers.

For a more detailed estimate of how much your surgery will cost in total, you should discuss this with your surgeon before the operation.

woman exercising after recovering from knee replacement surgery

Does Medicare cover knee replacement surgery?

If you don’t have hospital cover, Medicare will cover the entire costs of your total knee replacement. 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 system. According to the Australian Institute of Health and Welfare (AIHW), around half of Aussies on the waiting list for a total knee replacement waited 223 days for their surgery in 2019-20.3

So, if you’re looking to avoid the public waiting list and get back to healthy living faster, you’ll need to take out an appropriate level of hospital cover.

Which type of health insurance covers knee replacement surgery?

Gold hospital policies cover knee and other joint replacement surgeries. However, depending on the health fund, joint replacement surgeries may also be included in Silver Plus policies. This is why it’s important to shop around.

Through our free health insurance comparison service, you can compare a range of policies in just minutes. We can help you from the beginning to the end of the purchase. Need help? Call our friendly team with any questions you might have on 1800 338 253.

Sources

  1. Australian Government Department of Health. The March 2020 Medicare Benefits Schedule. 2020. Accessed January 2020.
  2. Australian Government Department of Health. Hospital Casemix Protocol Annual Reports. 2020. Accessed January 2020.
  3. Australian Institute of Health and Welfare. Elective surgery waiting times 2019-20: Australian hospital statistics. Accessed January 2020.

So, what are you waiting for?

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