While a hip replacement can be an effective way for many patients to reduce pain and restore mobility, it can also be an expensive process. Whether you choose to go through the public or private system for your hip replacement, you’ll most likely end up with a number of out-of-pocket costs, which could be fairly significant.
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, Healthdirect Australia says.
Hip replacements are generally recommended for those with long-lasting hip pain that makes moving difficult, and is having a significant impact on quality of life. A hip replacement can help to potentially alleviate this pain and subsequently improve one’s quality of life.
How much will a hip replacement cost me as a public patient?
The Medicare Benefits Schedule (MBS) lists a range of hip replacement procedures which Medicare will provide a 75% benefit for, ranging 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. The listed fees for these services range from $860.90 to $2,487, and the benefit provided ranges from $645.70 to $1,865.25. So if you choose to have your hip replacement carried out through the public system, you could incur an out-of-pocket cost between $215.20 and $621.75. Keep in mind, however, that surgeons and other medical practitioners are allowed to set and charge their own fees, which may end up exceeding the fee listed in the MBS.
While having your hip replaced through the public system could potentially see you pay less in out-of-pocket costs than going through the private system, waiting list times for procedures can be significant. Data from the Australian Institute of Health and Welfare showed that in the 2017-18 period, some patients had to wait up to 354 days for a procedure, while 10% of patients faced longer waits.
Conversely, undergoing a hip replacement as a private patient will generally involve a shorter wait but a potentially larger out-of-pocket cost.
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 Medibank Surgical Variance Report 2017 shows that that the median out-of-pocket cost for a hip replacement was $141, but the average out-of-pocket cost was $2,054 across the two years to July 2016.
Do different surgeons charge different amounts for hip replacements?
The Medibank report found that the average total cost of a hip replacement ranged between $19,439 and $42,007, and that some surgeons charged out-of-pocket costs as high as $5,567 for a hip replacement.
The report also found that just over a third of surgeons charged no out-of-pocket fees for orthopaedic operations, but that when it came to hip replacement surgeries specifically, 42% of patients paid an out-of-pocket cost.
Will my choice of health insurer affect my out-of-pocket costs?
Different health insurers may provide varying benefit levels and maximums for hip replacement surgery. For example, Bupa quotes an average procedure cost of $31,820 and an average out-of-pocket cost of $1,120, whereas HCF quotes a total cost of $28,218 and an out-of-pocket cost of $967.
However, your total out-of-pocket costs will vary depending on your personal circumstances, including your health insurance policy and the surgeon you choose to do your hip replacement.
Which state is the cheapest for knee replacement surgery?
The most recent relevant Medibank report from 2017 calculated the average out-of-pocket costs customers were charged by surgeons in different states and territories for hip replacements. They were as follows:
- ACT – $2,591
- NSW – $2,673
- NT – $2,697
- Qld – $1,827
- SA – $556
- Tas – $681
- Vic – $1,997
- WA – $799
With a $2,141 difference between the cheapest and most expensive states and territories, it may be worth considering the potential merits of travelling interstate if you require a hip replacement and live in a state where it is more expensive on average. However, do keep in mind costs such as travel, accommodation, insurance, as well as whether or not your health insurer provides cover for interstate surgery.
What tiers of health insurance cover hip replacements?
Joint reconstructions must be covered on an unrestricted basis on Bronze, Silver, and Gold health insurance policies according to the hospital cover tier system which was launched in April 2019. Joint reconstructions may also be covered on certain Basic Plus policies, as they are not a minimum requirement of the Basic tier but insurers may choose to offer cover for them on a restricted or unrestricted basis.
That being said, while cover for joint reconstructions is mandatory on most health insurance policies, excesses, cover limits, and maximum payable benefits may vary significantly by policy and product tier. You can compare health insurance policies with Canstar.