How Much Does a Knee Replacement Cost in Australia?
What a knee replacement costs in Australia across the public, private and self-funded pathways — including wait times, gap fees, and Dr Rhys Clark's no-gap policy for insured patients.
Cost of Knee Replacement Surgery in Australia
It is crucial for everyone thinking about undergoing knee replacement surgery to understand the financial implications of this major medical treatment. The purpose of this guide is to provide information on the cost of a knee replacement in different Australian healthcare settings. Please visit our knee replacement page for more clinical details regarding the actual surgery.
1st Choice: Public System – What Is the Cost of a Knee Replacement?
Your general practitioner can start the process by referring you for a knee arthritis assessment if you are eligible for Medicare. This referral is sent to a hospital that services your area after being reviewed through a centralised system and triaged according to urgency (knee arthritis usually obtains a low priority). Appointment waiting times can be long, sometimes lasting from several months to years.
After your initial appointment, you may require further diagnostic procedures, such as X-rays. An orthopaedic doctor will examine you and determine if you should get a knee replacement. You will be placed on a waiting list for surgery after giving your agreement. This surgical waitlist can be months or years before you get your knee replacement.
- Benefits: Since Medicare covers this option, there are no out-of-pocket expenses associated with surgery.
- Cons: You are not allowed to choose your surgeon, and there may be long wait times.
- Note: In some rural areas and some states there are no public outpatient clinics in the hospital, so patients are directed to private surgeon rooms. Direct referrals to private surgeons who can put patients on public waiting lists may come with upfront payments.
2nd Choice: Private System – How Much Does a Knee Replacement Cost Australia?
Private health insurance holders can expedite the procedure. Your general practitioner will recommend a private surgeon, with appointments typically available in four to six weeks. If a knee replacement is advised after evaluating your needs, surgery can usually be scheduled six weeks after your visit to accommodate pre-operative physical therapy.
You will receive all the information you need to confirm coverage and potential excess fees with your insurance carrier during your booking, including the MBS code and anaesthetist’s details.
The difference between the surgeon’s price and what your insurance pays is known as the “gap fee,” and it varies. I don’t charge extra because I work on a no-gap basis, matching my costs to what your insurance will pay. Some surgeons set a much higher fee than what the health fund will pay, which results in a large gap that the patient pays. Please note that a larger gap does not mean that you get a better surgeon, rather that a surgeon chooses to set their fees higher.
3rd Choice: Self-Funded – How Much Does a Knee Replacement Cost?
Self-funding is an alternative if you do not have private insurance and would rather not wait for treatment through the public system. This entails paying cash for all associated services. The entire cost of a knee replacement, including hospital stays, the prosthesis, and surgery expenses, often falls between $25,000 and $35,000.
About one-third of these expenses should be covered by Medicare payments.
How much does a knee replacement cost in Australia?+
It depends on the pathway. Through the public system under Medicare there are no out-of-pocket surgical costs, but wait times can run from months to years. Privately insured patients pay whatever excess and gap their fund leaves; Dr Clark works on a no-gap basis, matching his fees to what the insurer pays. Self-funded patients typically pay between $25,000 and $35,000 in total, covering the hospital stay, prosthesis and surgical fees, with about one-third of that usually offset by Medicare rebates.
What is a gap fee?+
The gap is the difference between the surgeon's fee and what your health insurer pays. It varies between surgeons. Dr Clark charges no gap, setting his fees to match the insurer's payment. A larger gap does not indicate a better surgeon — only that the surgeon has chosen to set higher fees.
How long is the wait for a knee replacement in the public system?+
Potentially a long time. Your GP refers you for assessment, the referral is triaged centrally, and knee arthritis usually receives a low priority. Waiting for the initial appointment can take months to years, and there is then a further surgical waiting list which can also run to months or years.
How much faster is going private?+
Considerably. Appointments with a private surgeon are typically available within four to six weeks, and if a knee replacement is recommended, surgery can usually be scheduled about six weeks after that visit — the interval allowing time for pre-operative physiotherapy.
Does Medicare cover a knee replacement?+
In the public system Medicare covers the surgery, so there are no out-of-pocket surgical expenses. For self-funded patients, Medicare rebates typically cover around one-third of the total cost.
Can I choose my surgeon in the public system?+
No. Choosing your own surgeon is one of the main differences between the private and public pathways, along with the wait time.