Will health insurance cover my knee replacement?  

Knee replacements are one of the most common elective surgeries in Australia, with around 53,000 performed a year for osteoarthritis. For those people, and those with knee injuries, knee replacement surgery can be life-changing, giving back mobility and flexibility… but they often have to wait several months for it.

For that reason, having Hospital Cover that includes Joint Replacements can make a big difference, allowing you to schedule knee replacement surgery much faster. You may also be able to select a private hospital and a surgeon of your choice, and even get your own hospital room (if available). Here’s what you need to know about health insurance and knee replacements. 

How much is a knee replacement? 

According to Medical Costs Finder, hospital fees for a knee replacement are around $18,000. Doctor and specialist fees are an average of $4,900, but bear in mind, Medicare will cover part of that. Doctors’ fees can vary wildly so always get a full rundown of costs in advance from all doctors and specialists involved, and talk to your insurer to find out how much will be covered. 

There may be an excess as well as a Gap for you to pay, depending on your policy and doctors. In 2022-23, 78% of people who used Private Health Insurance for a knee replacement had to pay out-of-pocket costs, with the average being $880. 

What is a Gap?

What health insurance policies cover knee replacements? 

Knee replacements are covered by the Joint Replacements Clinical Category of Hospital Cover, which is usually only available on Gold tier policies (but some insurers may choose to offer it on Bronze and Silver policies).   

What are the tiers of Hospital Cover and what do they cover?

When you start a Gold tier policy, or upgrade to one from a lower tier, you’ll have to serve a 12-month waiting period before you can claim for a knee replacement. Make sure you check the policy limits carefully. 

It might be a good idea to also get Extras Cover, to help with your rehabilitation after surgery. Extras will cover you for some of your physiotherapy or occupational therapy costs. 

What’s the best health insurance for knee replacements? 

The best health insurance policy for a knee replacement is one that offers you the cover you need at the right price for you. You’ve got a lot of options available, and here at healthslips.com.au we’re the only comparison website that shows you all of them. Our calculator is free to use and you don’t have to enter your contact details.  

Find health insurance cover for knee replacements here. 

Trudie McConnochie

Writer and Researcher

Knowledge is power – that’s the guiding principle behind everything Trudie writes, and it’s a philosophy she brings to her work at healthslips.com.au. By breaking down complex information into easy-to-understand blogs and stories, she aims to empower Australians to make the best choices and an informed decision around private health insurance.

Trudie understands firsthand some of the complexity of private health insurance having moved to Australia from New Zealand and having to navigate a vastly different public healthcare system and health insurance structure.

Trudie holds a Bachelor of Communication Studies (journalism major) from the Auckland University of Technology.

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