Hip replacement surgery cost

What is a hip replacement?

Hip replacement surgery, also known as total hip arthroplasty, is a medical procedure in which either some or all of the bones comprising the hip joint are removed and replaced with either a metal or plastic prosthesis designed to mimic the natural function of the joint. A hip replacement can help to potentially alleviate pain and restore mobility—subsequently improving one’s quality of life.

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How much does a hip replacement cost without insurance?

Total hip replacement surgery typically costs around $24,000 according to the Federal Government’s Department of Health and Aged Care. This doesn’t factor in any Medicare benefits, which could bring down the total cost, or whether you are being treated in a private or public hospital. If you were to have your hip replacement surgery done in a private hospital without private hospital cover, you could expect to pay over $22,000. Whether you choose to go through the public or private system will determine how much, if any, out-of-pocket costs you incur.

How much will a hip replacement cost me as a public patient?

If you choose to have your hip replacement carried out through the public system, there will typically be low or no out-of-pocket costs. Keep in mind, however, that surgeons, specialists and other medical practitioners are allowed to set their own fees and how they are charged, which may incur a cost.

While having your hip replaced through the public system could potentially see you pay nothing in out-of-pocket costs, waiting list times for elective procedures can be significant. Data from the Australian Institute of Health and Welfare shows that in the 2023-24 period, the median wait time nationally for patients to be admitted for total hip replacement was 135 days. As a private patient undergoing a hip replacement, there will generally be a shorter wait, but larger out-of-pocket costs.

How much will a hip replacement cost me as a private patient?

If you choose to have your hip replacement carried out through the private system, data from the Department of Health and Aged Care shows that the median out-of-pocket cost for a hip replacement was $1,000. For those undergoing bilateral hip replacement (both hips), the median out-of-pocket cost was $4,800.

These costs factor in contributions from your private health insurer and Medicare—through the Medicare Benefits Schedule (MBS). The Medicare Benefits Schedule lists a range of hip replacement procedures which Medicare will provide a 75% benefit for. These range from a basic partial arthroplasty through to a total hip replacement requiring bone grafts (replacement or substitution of bone tissue) for both the pelvis and femur.

It’s important to note that these costs may not cover hospital fees, which are typically around $19,000 for this type of procedure. The hospital excess you pay and what procedures are covered is generally determined by your private health insurance policy. If you wish to be treated as a private patient in a public hospital, in order to potentially have a private room and your choice of health professional, you would need to pay your private health insurance’s hospital excess.

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Do different surgeons charge different amounts for hip replacements?

The Department of Health and Aged Care’s data shows that the total out-of-pocket cost can range from as low as $180 to as high as $4,500. One of the factors that influences hip replacement surgery costs is your choice of surgeon and/or specialist. Surgeons and specialists typically set their own fees, which can vary depending on their level of experience and the area in which they are located. It’s important to ask questions about potential fees and costs during any initial consultations. If you know what treatments or services you’ll need, you can request a written estimate of fees and out-of-pocket costs from your chosen medical practitioner.

Will my choice of health insurer affect my out-of-pocket costs?

Different health insurers may provide varying benefit levels and limits for hip replacement surgery. For example, Medibank quoted an average procedure cost of $24,387 and an average out-of-pocket cost of $651 based on procedures undertaken in 2021, whereas HCF quoted an average total cost of $28,386 and an average out-of-pocket cost of $1,372 based on claims from July 2023 to June 2024. These average out-of-pocket costs do not include any excess the policyholder might need to pay and are based on the patient using a hospital within the insurers’ partner networks. So, depending on your circumstances, your out-of-pocket costs may be different.

When it comes to what the out-of-pocket costs consist of, HCF gives the following example breakdown, based on the averages of eligible hip replacement claims it processed between 1 July 2023 to 30 June 2024:

• Orthopaedic surgeon: $414

• Anaesthetist: $462

• Assistant surgeon: $210

• Other clinician: $231

• Radiologist: $43

• Specialist consultations: $13

These average figures are just a guide and your total out-of-pocket costs and what they’re made up of will vary depending on your personal circumstances including: your health insurance policy and excess payable, the hospital you attend and the surgeon you choose to perform your hip replacement. It may be worth speaking to your health insurer or healthcare professional for more information.

Which state is the cheapest for hip replacement surgery?

The Department of Health and Aged Care’s data calculated the median out-of-pocket costs patients were charged in certain states and territories for hip replacements. They are as follows:

• ACT – $4,000

• NSW – $1,900

• Qld – $1,100

• SA – $400

• Vic – $1,000

• WA – $500

At the time of writing no figures for The Northern Territory or Tasmanian were provided.

What tiers of health insurance cover hip replacements?

Joint replacements are only covered as a minimum requirement on Gold hospital policies, according to PrivateHealth.gov.au. However, joint replacements may also be included as an optional level of cover on Silver and Bronze policies. Where that is the case, the policy becomes a ‘Silver Plus’ or ‘Bronze Plus’ policy as the provider is offering cover beyond the minimum requirements of those tiers.

Providers also have the option of including cover for joint replacements on their Basic hospital policies but on a restricted basis. This means the policyholder would be partially covered for hospital costs as a private patient in a public hospital but may incur significant expenses in a private hospital. It’s worth checking with your insurer and hospital for details of what your policy will and will not cover.

Remember that while joint replacements may be covered on a private health insurance hospital policy, excesses, cover limits, waiting periods and maximum payable benefits may vary significantly by policy and product tier. It’s important to read the Private Health Information Statement (PHIS) carefully and compare private health insurance policies to help ensure you’re getting a level of cover that is suitable for your needs.

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