How much does a hip or knee replacement cost?

It depends on your health fund, your level of cover and the hospital, so there is no single honest number. What is promised instead is that you get every cost in writing before surgery is booked, and nothing goes ahead until you have seen the numbers. The government's Medical Costs Finder website shows what patients typically pay around Australia.

What does "no gap" mean?

It means the surgeon's fee is fully covered by Medicare and your health fund together, so you pay nothing for the surgeon. The anaesthetist and surgical assistant bill separately and may charge their own gap, and your policy excess may still apply. Dr Broadhead has no-gap arrangements with a number of health funds at particular hospitals; reception can tell you if your fund is one of them.

What does "known gap" mean?

It means you do pay something out of pocket for the surgeon's fee, but it is a fixed amount you are told in writing before surgery, never a surprise afterwards.

Does my private health insurance cover joint replacement?

Only if your hospital policy includes the category called "Joint replacements". All Gold policies include it. Silver, Bronze and Basic policies usually do not, unless the fund has added it (often sold as "Plus"). Ring your fund and ask the exact question, "Does my policy cover the clinical category 'Joint replacements', and have I served the waiting period?"

What if I don't have private health insurance?

You have two paths. The public hospital system does the operation at no cost to you, with a waiting list. Or you can pay for private surgery yourself, with a complete written costing first so you know the full amount before deciding.

Is the first consultation covered by Medicare?

With a valid referral, yes, Medicare pays a rebate on the consultation, and reception tells you the fee and the rebate when you book. Seeing Dr Broadhead does not commit you to surgery; many patients are best served without an operation.

The cost of hip and knee replacement in Australia

What an operation costs is one of the most confusing parts of Australian healthcare, different health funds pay different amounts, and different hospitals have different arrangements. It confuses everyone. This page explains it simply.

The short version

Public hospital: the operation costs you nothing, but there is a waiting list.
Private with insurance: Medicare and your health fund pay most or all of it. Sometimes you pay nothing extra (“no gap”). Sometimes you pay a fixed amount you are told beforehand (“known gap”).
Private without insurance: you can pay for the surgery yourself, with the full price in writing first.
Either way, you always get the costs in writing before surgery is booked. No surprises. That is a promise, and it has a name, informed financial consent.

The rest of this page explains each piece. If you only do one thing, make it the phone call in the section on checking your insurance.

Going public: no cost, but a wait

Joint replacement in a public hospital is free for the patient. Medicare covers it. The trade-off is time; you join a waiting list, and how long it takes depends on where you live and how urgent your case is. For some people this is the right path, and it is discussed honestly when it is.

Going private: who pays what

A private operation is not one bill. It is a few separate ones:

The hospital bill, your room, the operating theatre, and the implant itself. Your health fund pays this if your policy covers joint replacement. You may pay an excess, the same way you would with car insurance.
The surgeon’s bill.
The anaesthetist’s bill, and sometimes a surgical assistant’s. They bill separately, and their details come with your quote so you can check their costs too.

The surgeon’s bill, step by step

Medicare sets an official price for every operation. It is called the schedule fee, and it has not kept up with the real cost of providing care, so most surgeons charge more than it. Dr Broadhead sets his fees using the Australian Medical Association’s published fee list as the guide, rather than an arbitrary number.
For surgery in hospital, Medicare pays 75% of the schedule fee and your health fund pays at least the other 25%.
What happens to the rest (the part above the schedule fee) is called the gap. Three things can happen to it:

No gap. Your fund covers the whole of the surgeon’s fee. You pay nothing for the surgeon. The anaesthetist, surgical assistant and hospital bill separately, so ask about their fees too. Dr Broadhead has no-gap arrangements with a number of health funds at particular hospitals.
Known gap. Your fund covers most of it, and you pay a fixed amount that you are told in writing before surgery.
Outside the fund’s scheme. The fund pays only its minimum share and the rest is yours. If this would apply to you, it is spelled out in the quote; you will never discover it afterwards.

One thing catches people out: the same fund can be “no gap” at one hospital and not at another. Occasionally that means a real choice, no gap at one hospital, or a gap at a more convenient one. If that trade-off applies to you, you get it laid out plainly, with the numbers, and you choose.

Check your insurance covers it; this is where people get caught

Hospital policies come in four levels: Gold, Silver, Bronze and Basic. Joint replacement sits in an official category called “Joint replacements”, and only Gold policies must include it. Silver, Bronze and Basic usually do not, unless your fund has added it as an extra (often sold with “Plus” in the name).

So don’t ask your fund “am I covered for my knee?”, the answer can mislead. Ring them and ask exactly this:

“Does my policy cover the clinical category called ‘Joint replacements’, and have I served the waiting period?”

While you have them on the phone, ask two more things:

“Is there an excess on a hospital admission, and how much?”
“Are there hospitals my policy doesn’t fully cover?”

And one warning worth knowing early: if you upgrade your cover to get joint replacement included, there is usually a 12-month wait before you can use it for a condition you already have, and arthritis that is already being treated counts.

What you can check yourself

The Australian Government runs a free website, the Medical Costs Finder, which shows what patients across Australia typically paid for hip and knee replacement, the typical specialist fees, what Medicare and funds contributed, and typical out-of-pocket amounts. It is a good way to get a feel for the numbers before your consultation, from an independent source.

What happens at this practice

At the consultation, surgery is only recommended when it is genuinely the right next step. Most hip and knee arthritis is managed without an operation.
If surgery is planned, you receive a written quote for the surgeon’s fee (showing what Medicare pays, what your fund pays, and any gap) plus the contact details to confirm the anaesthetist’s and hospital’s costs.
Nothing is booked until you have the numbers and are happy with them.

Reception can tell you before you book which health funds have gap arrangements with Dr Broadhead, and at which hospitals, call (02) 9052 1883.

Your health fund is the only one who can confirm your own policy. But armed with the right question, it is a short phone call.