Hip and knee replacement in Australia: Medicare, private health, waits and cost

Protocol Archive → Will it be covered? → Hip and knee replacement → Australia

Hip and knee replacement in Australia: Medicare, private health, waits and cost

General information only. Not medical, insurance or legal advice. Coverage rules and prices change, so confirm with your insurer or public health service (such as the NHS, HSE or Medicare) before booking, and ask your doctor whether a procedure is right for you.

Last checked: October 2026 · Protocol Archive Editorial · General information, not medical, insurance or legal advice

MBS fees are set by the Australian Government and updated each July. Your doctor can charge more than the schedule fee. Ask for the item numbers and a written estimate (informed financial consent) before treatment.

Public hospital

As a public patient in a public hospital, joint replacement costs you nothing. The AIHW reported median waits in 2024–25 of 130 days for total hip replacement and 255 days for total knee replacement.

Private hospital

  • Joint replacements are only a minimum requirement of Gold hospital cover.
  • Medicare pays 75% of the schedule fee for the surgeon (items 49318 hip and 49518 knee).
  • Medical Costs Finder (2023–24): 84% of privately insured hip replacement patients and 82% of knee replacement patients had an out-of-pocket medical cost. Typical specialists’ fees were about A$5,200 to A$5,600. Hospital fees, typically A$18,000 to A$20,000, are separate; your private health insurance may cover all or part of them.
  • If you had signs or symptoms of arthritis in the 6 months before you joined or upgraded, your insurer can apply a waiting period of up to 12 months.

How coverage works in Australia

As a public patient in a public hospital, you are treated at no charge, but you may wait. For specialist care outside hospital, Medicare pays 85% of the Medicare Benefits Schedule (MBS) fee; as a private patient in hospital it pays 75% and your private hospital cover pays the rest of the schedule fee. Doctors can charge more than the schedule fee, so you may have a “gap” to pay. How coverage works in Australia.

Private hospital cover: waiting periods

Private hospital cover can have waiting periods of up to 12 months for pre-existing conditions and up to 2 months for most other treatment. A condition counts as pre-existing if you had signs or symptoms in the 6 months before you joined or upgraded; a doctor appointed by your insurer decides this.

If you are refused

  • Ask your insurer which clinical category and policy rule applies, and get it in writing.
  • If you can’t resolve it, the Commonwealth Ombudsman handles private health insurance complaints for free.
  • Complaints about a health service go to your state’s health complaints body, such as the Health Care Complaints Commission in NSW or the Health Complaints Commissioner in Victoria.

Frequently asked questions

Do I need Gold cover for a knee replacement?

Joint replacements are only a minimum requirement of Gold hospital cover. Some lower-tier policies may include them as an option, so check your policy.

Exercises before and after joint replacement

Exercise and staying active are part of most treatment plans, whether or not you have an injection or surgery. These free routines and printable sheets are a good place to start. Your surgical team will tell you which exercises suit you after an operation.

A physiotherapist can tailor an exercise plan to you.

Sources

  1. AIHW MyHospitals: Median waiting time for elective surgery, 2024–25
  2. MBS Online: Item 49318 (total hip replacement)
  3. MBS Online: Item 49518 (total knee replacement)
  4. Medical Costs Finder: Hip replacement
  5. Medical Costs Finder: Knee replacement
  6. privatehealth.gov.au: Product tiers
  7. privatehealth.gov.au: Overview of the health system
  8. privatehealth.gov.au: Out-of-pocket costs
  9. privatehealth.gov.au: Waiting periods
  10. Commonwealth Ombudsman: Private health insurance complaints
  11. Health Care Complaints Commission (NSW)
  12. Health Complaints Commissioner (Victoria)

Last checked October 2026. Found something out of date? Email hello@protocolarchive.com.

This page explains how coverage usually works, using public Australian Government, insurer, ombudsman and clinic sources listed above. It is general information, not medical, insurance, financial or legal advice, and it does not recommend any treatment, policy or provider. Rules differ by policy and can change, so confirm with your doctor, your insurer or the hospital before you decide. Protocol Archive is independent and is not affiliated with Medicare, the Australian Government or any insurer.