Wondering what the cost of a hip replacement in Australia is? Should you go with a public or private healthcare provider? Below we’ll break down the varying costs so you can find the right route for your hip replacement.
- The average cost of hip replacement surgery is between $20,000-$40,000.
- With private health, you could pay as little as just over $1,000 for your surgery
- If you go public (with Medicare), there are lower out-of-pocket costs, but you may experience longer waiting times and won’t get to choose your surgeon or hospital.
When it comes to hip replacement surgeries, the options can seem overwhelming. With costs varying drastically and the choice between public and private healthcare, how do you decide what’s right for you? This guide aims to demystify the process, laying out everything from what the surgery involves to how to choose the best health fund for your needs.
Cost of Hip Replacement Surgery
The average cost of hip replacement surgery varies dramatically, but estimates often range in the $20,000 to $40,000 range.
The Medicare Benefits Scheme fee for hip replacement as of August 2023 is $1,443.35, with a 75% benefit ($1,082.55).
The amount your health fund will pay depends on your level of cover – but typically you’ll need a silver hospital policy or higher to be covered for hip replacement surgery (which falls under the category of joint replacement surgery)
Determining Your Out-of-Pocket Costs
- Call Your Surgeon: Find out their cost for a hip replacement. Prices can vary significantly, even more than $20,000.
- Check with Your Health Insurer: Ask if your surgeon is on your insurer’s preferred list. This might make it more affordable.
- Ask About Extras: Inquire about additional costs, such as an anaesthetist, as these can add up.
- Look for Hidden Costs: Ensure there are no hidden charges like X-rays, which could unexpectedly increase the total price.
- Get the Medicare Code: Your surgeon should provide you with this code, essential for the next step.
- Call Your Private Health Insurer: Provide them with the Medicare code to understand how much they’ll cover.
- Contact the Anaesthetist: Ask for a cost estimate from the anaesthetist. It’s vital to know this upfront.
- Find Out Your Doctor’s Rebate: Ask your surgeon if there is an estimated rebate available.
EXAMPLE: Hip Replacement with HCF
Total service cost: $27,680
HCF pays: 86%
Medicare pays: 10%
You pay: 4%
YOUR TOTAL OUT OF POCKET COSTS: $1,135
Cost based on: participating private hospital; Nil excess; doctors participating in an HCF gap arrangement.
Benefits of Private Health Cover for Hip Replacement Surgery
Pick Your Team: Going private usually means you get to choose your surgeon and hospital.
Set the Date: You’ll have more say over when your surgical procedure takes place. Less waiting around means you can get back to living life sooner.
Get the Right Cover: To be all set, you’ll need a private hospital policy. We’re talking medium to high level (Silver or Gold cover).
Waiting Periods: If this is your first time getting joint replacement cover, there’s a 12-month waiting period.
Out-of-pocket costs: Even with private health insurance, you’ll still face some out-of-pocket costs, depending on your excess and the surgeon fees.
How Does Your Chosen Health Fund Affect Your Hip Replacement Costs?
Different insurance companies offer different packages and benefits. For example, for hip replacements:
- Bupa: Average cost is $31,820, with an average out-of-pocket cost of $1,120.
- HCF: Average total cost of $28,286, and an average out-of-pocket cost of $1,009.
But remember, these numbers are usually just the baseline costs, they don’t include all the extra bits you might have to pay, like the excess. And they’re based on using a partner hospital, so your costs might be different.
Here’s a rough breakdown from HCF, based on their average eligible hip replacement claims:
- Orthopaedic surgeon: $359
- Anaesthetist: $423
- Assistant surgeon: $100
- Other clinician: $68
- Radiologist: $52
- Specialist consultations: $7
But remember, these are just average figures, and your costs could be different. It’s important you talk to your insurer or healthcare professional for the full picture.
Where you live can also affect the price. Here’s a snapshot of average out-of-pocket costs for different states, according to Medibank:
- ACT: $2,591
- NSW: $2,673
- NT: $2,697
- Qld: $1,827
- SA: $556
- Tas: $681
- Vic: $1,997
- WA: $799
What Health Insurance Policy Covers Hip Replacements?
Only Gold hospital policies must cover joint replacements, but some Silver and even Bronze policies might include it as an extra.
- Silver Plus/Bronze Plus: These policies include joint replacements as an extra.
- Basic Hospital Policies: They might offer restricted cover, meaning you’re partially covered, but there might be more out-of-pocket expenses.
Different policies can have different excesses, cover limits, and benefits, so make sure you read the fine print, compare policies, and find the one that suits your needs.
Does Medicare Cover a Hip Replacement?
Medicare has got you covered for necessary surgeries like hip replacements. If you’re a public patient, you can expect no out-of-pocket expenses for surgery in a public hospital.
Plus, Medicare will pay 75% of the Medicare Benefits Schedule (MBS) fee for private patients in public hospitals. That means they’ll cover three-quarters of the costs for the surgery itself, as well as the anaesthesia and any tests you might need.
However, while Medicare can make hip replacements more affordable, especially in public hospitals, there might be a waiting game involved. You could be waiting several months before your surgery date arrives. And don’t expect to pick your doctor if you’re going the public route.
Average public vs private wait times for hip replacement surgery
- Public: 130
- Private: 50
How to Claim the Medicare Rebate
Claiming your Medicare benefit can be done through your Medicare online account on myGov or your doctor might handle it for you.
Cost of Hip Replacement As a Public Patient?
The MBS covers a range of hip replacement procedures for Australian residents, from a simpler part fix (partial arthroplasty) to a full-blown overhaul (total hip replacement with bone grafts). Here are average the costs:
- Listed Fees: These vary from $776.80 to $2,524.30.
- Medicare’s Share: Medicare will cover 75% of those fees, which means benefits between $582.60 and $1,893.25.
- Your Share: Your out-of-pocket costs could be between $194.20 and $631.05. But be mindful that doctors can charge their own fees, so make sure to ask upfront.
Public System vs. Private System
- Pros: Lower out-of-pocket costs. You might end up saving more dough.
- Cons: Those waiting lists! You could be hanging around for a while. As of 2018-19, the average wait was 77 days for orthopaedic surgery (that’s the category hip operations fall under).
- Pros: Speedy service. You’ll likely get in sooner and pick your surgeon and hospital.
- Cons: Potentially higher out-of-pocket costs.
When is Hip Replacement Surgery Necessary?
Hip replacement (AKA total hip arthroplasty) might become a serious consideration when other avenues, such as physical therapy, exercise, and pain relief medication, just aren’t cutting it anymore. You may find yourself in need of a hip replacement if:
- Pain Persists: If medication no longer eases your pain, it might be a sign that something more needs to be done.
- Weakness in the Hip: When the hip becomes weak and unstable, it could be pointing toward the need for replacement.
- Limited Activity: If pain is holding you back from your usual activities or getting out and about, it might be time to consider surgery.
- Sleep Disturbance: Pain that’s affecting your sleep isn’t just a nuisance; it could be an indication that hip replacement is the next step.
Remember, this is a significant decision but can greatly improve your quality of life. It’s always best to consult with your healthcare provider to determine the right course of action for your unique situation.
What’s Involved in Hip Replacement Surgery
There are two main types of hip surgery: anterior and posterior.
Anterior Hip Replacement:
- What Is It?: This one’s a minimally invasive approach, known for faster recovery.
- How’s It Done?: While you’re under general anaesthesia, the surgeon makes a small incision on the front of the thigh.
- The Process: The femur bone gets separated from the acetabular socket, damaged bits are removed, and the acetabular prosthesis is secured.
Posterior Hip Replacement:
- What Is It?: A different approach, where the incision is near the buttocks.
- How’s It Done?: Under general anaesthesia again, the surgeon parts the muscle to access the hip joint.
- The Process: The femoral head is removed, and the artificial prosthesis is placed.
Recovery Time for Hip Replacement Surgery
- Short-Term Recovery (1-6 weeks): Expect some discomfort, but don’t worry, there’ll be painkillers to ease the pain. You’ll start moving with exercises and a walking aid. You’re getting the hang of it when you no longer need the aid and can move around the house without pain.
- Long-Term Recovery: Now, you’re back to work and daily activities. The wounds are healed, and you’re feeling like yourself again. It’s like finishing a long hike and enjoying the view.
Hip replacement surgery is a big step, but it can make a world of difference in quality of life. Whether you’re looking at the anterior or posterior option, knowing what to expect and what the recovery looks like can help you prepare.
Do different surgeons charge different amounts for hip replacements?
Different surgeons indeed charge varying amounts for hip replacements, with costs ranging from $19,439 to $42,007 according to a Medibank report. It also found that some surgeons charged out-of-pocket costs up to $5,567, while just over a third didn’t charge any extra fees at all. If you’re considering this surgery, the costs may vary widely, so it’s worth looking into your options.
How long do you stay in hospital for a hip replacement?
The length of your hospital stay after a hip replacement can vary, but it’s typically around 3 to 5 days. This depends on your overall health, the success of the surgery, and your progress in initial recovery. Your healthcare team will make sure you’re ready to go home and have the necessary support in place for ongoing recovery.
Should I go public or private for my hip replacement?
Choosing between public or private healthcare for a hip replacement is a personal decision and depends on several factors.
- Public System: There are little to no out-of-pocket costs, but you may experience longer waiting times and won’t get to choose your surgeon or hospital.
- Private System: You’ll likely have shorter waiting times, choice of surgeon and hospital, and more control over when the surgery takes place. However, this option may result in higher costs, even with private health insurance.