Knee replacement surgery promises mobility and relief, but what does it really cost? From public hospitals with minimal expenses to private care with possible out-of-pocket costs, understanding your options is crucial. We break it all down below.

SUMMARY

  • Knee replacements are generally considered elective surgery, which means you’d have to go on a waiting list if you get treated through the public healthcare system. Your procedure is free, however.
  • The average waiting time for a knee replacement without insurance was 255 days in 2020-2021.
  • Private hospital with insurance does incur some minimal costs, but you’ll have quicker access and choice of doctor.

When it comes to our health, we don’t want to cut corners. But we also want to know what we’re getting into, especially when it comes to something as significant as knee replacement surgery. If you’ve been feeling that persistent ache in your knee and wondering about taking the next step, you’re likely curious about the cost, particularly without insurance.

From being admitted as a public patient in the public system, to admission as a private patient in private hospitals, the price can range quite a bit. In this blog, we’ll dive into the cost of knee replacement surgery in Australia, dissecting the details, the differences, and how to make the best choice for your needs and budget.

Knee Replacement Cost Without Insurance

  • Knee Replacement Cost Factors: Your knee replacement costs will hinge on the surgery type. Medicare Benefits Schedule (MBS) sets the starting cost at $1,393.20, but that’s only the tip of the iceberg, as it doesn’t cover extra fees like accommodation or anaesthesia.
  • Location-Based Fees: Depending on where you call home in Australia, the average doctor’s fee might be anywhere from $3,600 to $7,000 for this type of surgery.
  • Potential Out-of-Pocket Costs: Even if Medicare covers the MBS fee fully, you might still have to fork over some cash. This out-of-pocket cost is known as a gap payment.

Understanding Knee Replacement Costs: Fees in 2021-22

When it comes to knee replacement in Australia, the cost isn’t a one-size-fits-all thing. Let’s unpack the typical costs, looking at some real-life examples for both public and private hospital patients:

Treatment Venue: In-Hospital

Public Hospital Patients

  • Costs: Nothing. As a public patient with Medicare, your procedure won’t cost you. However, aftercare – like physio and rehab might.

Private Hospital Patients

  • Potential Costs: If you’re heading to a private hospital, brace yourself for some out-of-pocket expenses. The numbers we’ll dig into below apply to those with Medicare and private health insurance for the procedure.

Typical Costs in 2021-22

For patients opting for knee replacement in a private setting, here’s a snapshot:

  • Out-of-Pocket Costs: 68% had to pay some extra cash.
    • Patients typically paid: $680
    • Medicare chipped in: $1,900
    • Insurance covered: $1,800
    • Typical specialists’ fees: $4,800
  • Included Costs: Specialist fees, assistant surgeon fees, anaesthetist fees (these may vary).
  • Excluded Costs: Hospital fees, usually around $18,000. This could cover accommodation, theatre, or medical devices. Don’t fret, your private health insurer will pick up most of the tab, depending on your insurance level. An excess or co-payment might still be on you though.

Out-of-Pocket Stats:

  • 32% of patients waltzed out with no extra costs
  • 68% had to pay a little something extra
    • High: $3,900
    • Typical: $680
    • Low: $150

As you can see, knee replacement costs vary widely, but this breakdown should give you a clearer picture of what to expect. Remember, speaking with your healthcare provider is the best way to get a tailored cost estimate for your specific situation.

Does Medicare Cover All Knee Replacement Surgery?

If You’re Going Public:

  • Medicare’s Role: Medicare has got your back. It’ll cover the entire cost of your total knee replacement in the public healthcare system.
  • Your Choices: Unfortunately, you can’t pick your doctor, hospital, or when you’ll have the surgery.
  • Waiting Time: You might be in for a wait. According to the Australian Institute of Health and Welfare (AIHW), half the folks waited 255 days in 2020-21, and 26% waited more than a year.
  • The Perks: Minimal or no out-of-pocket expenses.
  • The Downside: Waiting can be painful, literally. In 2021/22, 12.8% of public patients waited over a year for orthopaedic surgery.

If You’re Going Private:

  • Private Health Insurance: Want to get back on your feet faster? Private health insurance can help you skip the queue and choose your specialist.
  • Out-of-Pocket Costs: As a private patient, you could be looking at extra expenses, depending on the surgery type, your health insurance policy, hospital, and doctor choice.
  • Watch Out for Extras: Don’t forget the anaesthetist; they’ll cost extra too.
  • Know Before You Go: Make sure to get a written quote with detailed out-of-pocket costs to avoid surprises.

What Could You Expect to Pay with HCF?

As an example, say you have health insurance with HCF
. Here’s what your expenses will look like:

The total service cost of a knee replacement: $27,064

HCF
pays: 86%

Medicare pays: 10%

You pay: 4%

Your total cost: $1,098

These costs are based on a participating private hospital with nil excess and doctors in an HCF
gap arrangement. And remember, knee replacements have a lifespan. If things start to wobble, you might need a ‘revision knee replacement operation’.

Wait Times for Knee Replacement Surgery

  • If you are a public patient in a public hospital and you need a knee replacement, you will be placed on a long waiting list.
  • If you are a private patient with private health insurance having surgery in a private hospital, you can schedule your surgery according to the specialist’s availability

CHI TIP: If you have private health cover, you’ll need to make sure you’ve served your wait times before you can make a claim for knee replacement surgery. This can be anywhere from two months to 12 months, depending on the rules of your health fund.

How to Save on Knee Replacement Costs:

1. Have the Right Level of Cover

Find hospital cover that includes ‘joint replacement.’ This is typically in Gold hospital policies.

  • Look for ‘no gap’ coverage to avoid out-of-pocket expenses.
  • Compare premiums with tools like CHI to ensure you’re getting the best deal.
  • Review waiting periods with your insurance company to avoid surprises.

2. Consult with Your Medical Professionals:

  • Ask your GP for a referral to a specialist who might charge lower fees.
  • Discuss potential knee replacement costs, including hospital costs and potential Medicare rebate.

3. Understand the Procedures:

  • You might need an arthroscopy before a full replacement.
  • If it’s related to an ACL injury, ensure your hospital cover includes this.
  • Be clear about the MBS item number and corresponding costs.

4. Shop Around

  • Compare health funds to make an informed choice. A report from the Australian Medical Association (AMA) found some health insurers are much more generous than others when it comes to the rebates paid for knee replacement surgery (you could pay up to 26% less for a knee replacement surgery depending on your choice of fund). This is why it’s crucial to shop around!Which type of health insurance covers knee replacement surgery?

Gold hospital policies cover knee and other joint replacement surgeries. However, depending on the health fund, joint replacement surgeries may also be included in Silver ‘plus’ policies. This is why it’s important to shop around.

What is Knee Replacement Surgery?

Knee replacement surgery is typically performed by an orthopaedic surgeon to replace damaged knee parts with prosthetics, usually performed to relieve chronic knee pain. The surgery takes around 1-2 hours.

Types of Knee Replacement Surgery:

  • Total Knee Replacement: Entire knee joint replacement.
  • Revision Knee Replacement: Replacing worn-out prostheses.
  • Partial Knee Replacement: Replacing damaged ligaments while conserving good ones.
  • Kneecap Replacement: Only the kneecap is replaced.

When is Knee Replacement Needed?

You may need this surgery for conditions like osteoarthritis, rheumatoid arthritis, haemophilia, skeletal dysplasia, or avascular necrosis.

Rehab After Knee Replacement:

  • Immediate Post-Surgery: Standing encouraged within 24 hours, with hospital physiotherapy.
  • Continued Rehab: Regular physiotherapy possibly claimed through extras cover, with exercises to aid recovery.
  • Recovery Time: Knee strength and flexibility typically return after 12 months.

FAQs

1. What’s the Average Cost of a Knee Replacement Without Insurance in Australia?

The average cost of a knee replacement without insurance can vary widely across different states like NSW and VIC, and different hospitals within Australia. It typically ranges from $18,000 to $30,000. This includes the surgeon’s fee, hospital costs, anaesthetist fees, and possible additional expenses like physical therapy. It’s wise to request a detailed quote from the hospital to understand all potential costs involved.

2. Are There Any Government Subsidies or Medicare Rebates for Knee Replacement?

Yes, Medicare does provide some support for knee replacements, even if you’re not privately insured. The Australian Government may cover the procedure in a public hospital, but waiting periods apply. In some cases, a partial Medicare rebate may also be available for knee-related treatments like arthroscopy, although this won’t cover the entire cost. It’s essential to consult with the hospital and check the specific MBS item number to understand what might be covered.

3. What Factors Influence the Cost of a Knee Replacement Without Insurance?

Several factors can influence the total cost:

Location: Hospitals in major cities like Sydney may charge differently than those in regional areas.

  • Type of Surgery: Total, partial, or revision knee replacements, or specialised procedures like ACL repairs, may have different costs.
  • Surgeon’s Expertise: Fees can vary based on the surgeon’s experience and reputation.
  • Hospital Fees: Accommodation, theatre usage, and medical devices can add to the total cost.
  • Post-Surgery Care: Rehabilitation and physiotherapy, if not covered by hospital costs, can add to the overall price.

By understanding these factors and consulting with medical professionals, you can gain a clearer insight into the potential costs you might face without private health insurance. Always ask for a referral from your GP to an orthopaedic surgeon to get an accurate and personalised quote for your specific situation.