Hospital cover
Procedure costs
Specialists & hospitals
Preparing for hospital
Planning your recovery
A knee replacement costs approximately: $22,189 - $26,852
These are approximate costs~ based on claims data by Medibank members with eligible+ hospital cover for a hospital admission at a Medibank Members' Choice Hospitals. They don’t include doctors’ fees and outpatient appointments where you aren’t admitted into hospital.
Out-of-pocket costs vary based on your cover, your specialists' fees and the hospital.
The chart below shows how costs are typically split between Medibank, Medicare and your out-of-pocket costs:
Important information
This is not a quote and should be used as a guide only. The graph above shows a median view of costs for procedures (according to Medicare Benefits Schedule (MBS) item numbers, Adjacent Diagnostic Related Groups(DRGs) or International Classification of Diseases (ICD)) undertaken by Medibank members with eligible hospital cover for a hospital admission at a Medibank Members' Choice hospital, who have served the relevant waiting period claims, data received electronically (between 1/07/2023 and 30/6/2024) for Australian residents.
Typical procedure cost is based on the middle half of claims data.
We recommend you contact us prior to any hospital admission to:
check whether the procedure is an Included, Restricted or Excluded service under your policy;
confirm whether you have served relevant waiting periods;
and discuss any out-of-pocket costs you may have as part of your hospital admission.
You should also speak to your specialists and the hospital to discuss any out-of-pocket costs you may have as an outpatient. Benefits may not be available in the first 12 months of cover if the procedure relates to a pre-existing condition.
Out-of-pocket costs
When there are out-of-pocket medical costs, they’re typically due to charges for:
principal specialist/surgeon
anaesthetist
assistants
diagnostics (e.g. lab tests, medical imaging)
other specialists
non-PBS medications
Medibank members admitted to a non-Medibank Members’ Choice Hospital may incur higher out-of-pocket costs.
No Gap Joint Replacement program
Eligible members with hospital cover1 pay no out-of-pocket costs2 for included treatments and services as part of hospital admission3 for elective surgery for a hip or knee replacement at participating hospitals with participating surgeons, where clinically appropriate.
Further reading
Better Knee, Better Me
A program designed to help eligible Medibank members with painful knee osteoarthritis to reduce knee pain, improve their quality of life, and lower the chances of requiring joint replacement surgery.
Receive Rehab at Home
Eligible members can receive care from a registered health professional in the comfort of their own home, where clinically appropriate.**
Now that you’ve covered
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Looking for something else?
Find more tools and information in the Going to Hospital hub, from planning through to recovery.
Things you need to know
1 Must have hospital cover that includes Joint Replacement Surgery. Waiting periods apply.
2 An excess or co-payment may still be payable, depending on the product a member has chosen and whether they are claiming under their hospital cover for the first time in a calendar year. The Medibank Member Guide and Fund Rules sets out hospital benefit exclusions, which apply to all hospital admissions for Medibank members. There may be out-of-pocket expenses associated with outpatient appointments, such as your initial visit with a participating surgeon in their consulting rooms.
3 Excludes joint replacements resulting from an emergency admission.
** For eligible hospital members who have served waiting periods. Treating doctor must consider it appropriate. Services are subject to provider availability. Providers are not located in all areas and may change without notice. Additional treatment may incur out-of-pocket costs.
While we hope you find this information helpful, please note that it is general in nature. It is not health advice, and is not tailored to meet your individual health needs. You should always consult a trusted health professional before making decisions about your health care. While we have prepared the information carefully, we can’t guarantee that it is accurate, complete or up-to-date. And while we may mention goods or services provided by others, we aren’t specifically endorsing them and can’t accept responsibility for them. For these reasons we are unable to accept responsibility for any loss that may be sustained from acting on this information (subject to applicable consumer guarantees).