Joint Replacements

What is covered under Joint Replacements?

Hospital Cover for Joint Replacements includes hospital treatment for joint replacement surgery, including revisions, resurfacing, partial replacements and removal of prostheses. 

Examples include replacement of:

• toe joint
• ankle
• knee
• hip
• finger
• wrist
• shoulder.

This clinical category includes these treatments listed in the Medicare Benefits Schedule (MBS).

Some treatments you might expect to be in the Joint Replacements clinical category are under different clinical categories. For example, treatments for:

• joint fusions are listed under Bone, Joint and Muscle

• spinal fusions are listed under Back, Neck and Spine
• joint reconstructions like shoulder reconstructions are under Joint Reconstructions
• foot surgery is under Podiatric Surgery. 

Which Hospital Cover tiers include Joint Replacements?

What does it mean if cover is ‘optional’?

‘Optional’ means that the Australian Government allows insurers to choose whether or not to cover the clinical category under that Hospital Cover tier.

What does ‘restricted cover’ mean? 

Restricted cover means the insurer pays only limited benefits. 

If insurers offer cover for Joint Replacements under Basic Hospital Cover, they can do so on a ‘restricted’ basis. If you are admitted as a private patient in a private hospital for treatments under this clinical category, you will face considerable out-of-pocket costs.

Always check with your insurer before agreeing to be treated as a private patient in a private hospital if you have restricted cover for Joint Replacements. 

Does Medicare cover Joint Replacements?

Yes. Medicare includes all treatments under the Joint Replacements clinical category.

If there is an MBS item number for the treatment, Medicare covers it. 

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