What is a knee replacement?
Knee replacement surgery, also known as total knee arthroplasty or total knee replacement, is a medical procedure where parts of the knee joint are operated on and cut back to remove any diseased or damaged tissue. The removed joint parts are then replaced with metal and plastic prostheses that mimic the knee’s natural function.
It’s important to remember that all forms of knee replacement surgery have a finite lifespan. If your original knee replacement starts to work less effectively, you may at some stage need a revision knee replacement operation.
What is the cost of a knee replacement in Australia?
There are generally two ways to have knee replacement surgery performed – via the public system, which is covered by Medicare, or in a private hospital, where some or all of the costs are covered by health insurance with hospital cover. There is also the option of funding the full cost of the surgery in a private hospital, without health insurance.
Knee replacement in the public hospital system
If you're happy to have knee replacement surgery performed as a public patient in a public hospital, then the cost of knee replacement in a public hospital could be nothing.
One drawback of opting for the public hospital system is that you could be placed on the end of a long waiting list for surgery. For example, data from the Australian Health and Welfare Institute shows that in 2023-24, 50% of patients were admitted within 265 days for total knee replacement surgery in Australia. While this is down from the 308 day average recorded the year prior, it can still be a long time if you’re living with chronic pain and mobility loss.
Knee replacement with private health insurance
As a general guide, the Australian Government says the cost of a knee replacement in a private hospital for patients with private health insurance is approximately $1000. Specialist fees typically amount to $5,200, while hospital fees can be up to $18,000, with these expenses typically covered by private health insurance.
These costs do not cover other potential expenses such as the excess payable on your private health insurance, as well as specific diagnostic tests or pathology services, aftercare costs, the costs of pharmaceuticals, and assistant surgeon or anaesthetist costs that are not covered by Medicare. How much you’re likely to pay also depends on:
- the type of knee replacement surgery
- the excess under your health insurance policy
- the hospital you’re admitted to
- your choice of doctor
You could also face additional costs for your anaesthetist.
Before you commit to any procedures, you have the right to ask for a written quote that details your out-of-pocket costs, and it can be a good idea to do this for your peace of mind.
Private hospital, without health insurance (self-funded) knee replacement
The Australian Government estimates that the cost of a knee replacement, taking into account specialist fees and hospital fees, would be around $23,200. This means that the cost of a knee replacement in Australia without insurance, if you choose to go private, could be substantial.
Medicare may cover some of the costs, for example, specialist fees where a MBS item number applies. However, it may not cover private patient hospital costs, such as theatre fees or accommodation. If you choose to self-fund a knee replacement, it could be a wise idea to obtain written quotes from your treating doctors and allied health professionals, as well as from the private hospital.
Medicare Benefits Schedule (MBS) knee surgery costs vs Medicare rebate
The following table shows a range of knee replacement procedures and the associated out of pocket costs based on the Medicare Benefits Schedule (MBS) – a list of health professional services that the Australian Government subsidises.
The balance remaining after the 75% Medicare rebate represents a general estimate of the likely out-of-pocket costs for knee replacement surgery, however keep in mind that this could vary.
MBS | Surgery | MBS | Medicare | Balance |
|---|---|---|---|---|
Replacement | $828.55 | $621.45 | $207.10 | |
Partial | $1,374.30 | $1,030.75 | $343.55 | |
Total | $1,501.30 | $1,126.00 | $375.30 | |
Revision | $2,252.50 | $1,689.40 | $563.10 |
Source: MBS
How to save on knee replacement costs
Here are a few steps that could help you reduce the cost of knee replacement surgery:
Know what’s offered by your level of cover
If you’re relying on private health cover to pay for knee replacement surgery costs, you may want to confirm that your cover includes ‘joint replacement’. You can use Canstar’s comparison tool to compare hospital (or hospital and extras) policies that include this cover. The highest level of cover, Gold, generally includes this category of cover. Health insurance providers can also choose to add joint replacements to Bronze and Silver hospital policies, but it is optional, and the additional coverage is called a ‘Plus’ policy.
Ask your surgeon about out-of-pocket costs
There can be significant differences in the out-of-pocket costs charged by different surgeons. This can make it worth talking to your GP, and orthopaedic surgeon about the likely knee replacement costs. You may be able to partner with a specialist who charges a lower out-of-pocket cost.
Shop around and compare health fund providers
Some health insurers can be more generous than others when it comes to the rebates paid for knee replacement surgery.
The AMA releases its Private Health Insurance Report Card every February, and as the most recent figures show, your benefit could be 7% higher for a knee replacement surgery depending on your choice of fund. This difference highlights the value of shopping around between health insurance providers.
Benefits paid for knee replacement by different private health insurers (as at 1 November 2024)
MBS | Bupa | HCF | AGM/ | NIB | AHSA | HBF | Difference - |
|---|---|---|---|---|---|---|---|
$1,540.55 | $2,386.75 | $2,291.85 | $2,308.10 | $2,228.15 | $2,689.50 | $2,296.15 | $468.55 |
Source: AMA Private Health Insurance Report Card 2023. Costs don’t take into account other expenses such as anaesthetics
