Cover for knee replacement surgery with Australian Unity.
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Price based on :
Singles cover in VIC. I'm Under 65 with an income $105,000 or less, Rebate Tier 0 and a 4% discount for direct debit.
A knee replacement is a surgical procedure that replaces damaged or worn parts of the knee joint with artificial components. It is commonly recommended when knee pain and stiffness begin to affect everyday activities and other treatments are no longer providing relief.
Knee replacement surgery aims to reduce pain, improve mobility and help people return to activities they enjoy. There are a few main types of knee replacement surgery:
Yes. Knee replacements are covered under hospital cover. When comparing policies, check that Joint Replacements are included, as this is the Clinical Category that applies to knee replacement surgery. Don’t confuse Joint replacements with Joint reconstructions, which covers different procedures and does not include knee replacements.
Before undergoing surgery, it’s a good idea to check:
Knee replacements fall under the Joint Replacements Clinical Category, which is generally included in higher levels of hospital cover. Under the Australian Government's hospital cover tiers, Joint Replacements are included in Gold policies and health funds have also the option to include in the other tiers as well.
The most important thing is not the government tier itself, but whether Joint Replacements are included in the policy you're considering. If they are, you'll receive cover for knee replacement surgery regardless of whether the policy is classified as Silver Plus, Gold or other tier. Government tiers simply indicate the minimum Clinical Categories a policy must include; they do not determine benefit levels, hospital agreements, or out-of-pocket costs.
Both Medicare and private health insurance can help you access knee replacement surgery, but the experience can be quite different.
As a public patient under Medicare, you'll generally be treated through the public hospital system and may need to join a waiting list before surgery. You may also have limited choice over your surgeon and hospital. The benefit is that you won't pay hospital accommodation charges as a public patient.
With private health insurance, you typically have more choice and control over your treatment, including where you're treated, when you have surgery, and which specialist performs the procedure.
| Medicare (Public System) | Health insurance with knee replacement cover | |
|---|---|---|
| When you can have treatment | Treatment is subject to public hospital waiting lists, which can sometimes be lengthy. | Treatment may be available sooner. If you haven't previously held cover that includes Joint Replacements, you may need to serve a waiting period, often 12 months. After that, you'll generally have more flexibility when choosing a hospital and specialist. |
| Where you can have treatment | Public hospitals allocated through the public healthcare system. |
Choice of participating private hospitals and, in some cases, public hospitals. |
| Who can treat you | Limited ability to choose your specialist. | |
| Cost to have the surgery | No hospital accommodation charges, surgeon or anaesthetist fees. Although you may still incur costs for appointments, tests or medications outside your hospital stay. |
Depending on your policy, you may pay an excess or co-payment. Out-of-pocket costs may also apply for services provided by your surgeon or anaesthetist, as well as out-of-hospital appointments. |
Private health insurance can help cover many of the costs associated with knee replacement surgery, including hospital accommodation and theatre costs, provided Joint Replacements are included in your cover and any waiting periods have been served.
However, you may still need to contribute towards some costs, including:
The amount you'll pay depends on your policy, your specialists and the hospital where you're treated. Before surgery, ask your specialist for informed financial consent, which outlines any expected out-of-pocket costs so you can make an informed decision about your treatment.
With Australian Unity, our hospital only cover gives members access to Gap Cover, which can help reduce or eliminate some out-of-pocket costs when participating doctors use the scheme.
Knee replacement surgery may be covered by private hospital insurance when your policy includes the Joint Replacements Clinical Category. Medicare and your insurer will contribute towards your medical costs, such as your surgeon and anaesthetist fees. Your insurer will also pay benefits towards eligible hospital costs, including eligible prostheses. Medicare also covers eligible knee replacement surgery as a public patient in a public hospital. Your waiting time, provider choice and potential costs will differ depending on whether you are treated publicly or privately.
Yes, hospital cover that includes Joint Replacement will cover knee replacement surgery. Find cover that includes knee replacement cover.
For many Australians, private hospital treatment may provide access to surgery sooner than treatment as a public patient.
Waiting times depend on:
Private health insurance may offer greater flexibility when planning treatment.
Health insurance policies that include Joint Replacements can help cover the cost of knee replacement surgery as a private patient.
If you're looking for affordable hospital cover, our Value Hospital cover includes Joint Replacements and comes with a $100 daily co-payment, helping to keep premiums lower while still providing cover for a range of hospital treatments, including knee replacements. If you'd prefer to avoid a co-payment, Classic Hospital is another option that includes cover for Joint Replacements.
For broader cover, a combined hospital and extras policy such as Secure Choice includes Joint Replacements as well as extras cover for services commonly used before and after surgery, such as physiotherapy and other health services that support mobility and overall wellbeing.
Not sure which option is right for you? Call us on 1800 760 719 for help comparing your options, or explore the cover that include cover for knee replacement surgery.
Coverage varies by policy and provider arrangements. Australian Unity offers Hospital Care at Home which can cover rehabilitation at home for those eligible and where your doctor approves.
Confirm:
Knee replacement surgery is most commonly recommended when damage to the knee joint causes ongoing pain, reduced mobility and difficulty performing everyday activities.
Common conditions that may lead to knee replacement surgery include:
Your specialist will recommend treatment based on the severity of your symptoms, imaging results and how much your knee condition affects your quality of life.
Recovery is an important part of the knee replacement journey. Most people begin rehabilitation shortly after surgery to help rebuild strength, improve flexibility and restore movement in the joint.
Recovery plans may include:
Recovery time varies from person to person, but following your healthcare team's advice can help support the best possible outcome.
Eligible Australian Unity members may also be able to access Hospital Care at Home programs following surgery, where clinically appropriate and approved. Depending on the product Australian Unity extras cover can support recovery by helping with the costs of physiotherapy, gym memberships and support equipment.
