Your 3 step plan for choosing joint replacement cover

Hip and knee replacements are among the most common elective surgeries in Australia, and according to Private Healthcare Australia, that’s a major reason many people over 50 choose to have Hospital Cover. But if you think you might need a joint replacement in the future, you need to have health insurance at the right level. As the ABC reports, unfortunately some people find out too late that they’re not covered.  

With a 12-month waiting period for pre-existing conditions, you need to buy joint replacement cover well before you need the procedure. So here’s how to make sure you buy a policy that will cover you for joint replacement surgery. 

Already booked in for surgery? Find out how to claim for hip replacement or knee replacement surgery. 

Step 1: Check your Hospital Cover clinical categories 

Surgery to replace a joint – including hips, knees, shoulder, ankle, toe or finger – is covered by the Joint Replacement clinical category of Hospital Cover, not Joint Reconstruction. Since Joint Reconstruction is generally included on cheaper policies, it’s common for people to see this on their policy documents and assume they’re covered for joint replacement surgery – but the latter is only included on more expensive policies. Here’s a breakdown of procedure examples and the cover level (tier) needed. 

Step 2: Search for a policy 

If you want a policy that will definitely cover you for joint replacement, save yourself time by using the healthslips.com.au calculator – it shows you every policy from every insurer in Australia without bias. Make sure you have ‘joint replacements’ selected in your Hospital Cover clinical categories (filters is a helpful tool on your results) so you see policies that meet your specific need. There’s no need to enter your phone number or email address, which means you won’t get sales calls.  

Hospital Cover won’t cover your post-surgery rehabilitation costs after you’re discharged from hospital, though. To cover physiotherapy and additional mobility aids, you’ll need Extras Cover.  

Whatever policy you choose, you won’t have to pay for the artificial joint. This is funded by Medicare. 

Tip: Make sure there isn’t an ‘R’ next to ‘Joint Replacements’ on the policy. This means cover is restricted – so you’ll have much higher out-of-pocket costs.  

Our expert analysis 

We compared premiums for Silver Plus and Gold tier Hospital Cover that included Joint Replacements for a couple in Victoria. Here are the cheapest policies, as of August 2026. 

Hospital Cover, 2 adults, $750 excess: 

Step 3: Check the insurer’s network 

Before you buy a policy, check the insurer’s provider network on their website. Most insurers list the specialists they have Gap cover arrangements with. Filter it by orthopaedic surgeons in your area and make sure there are plenty of options with that insurer, which could mean lower (or no) out-of-pocket costs for your joint replacement procedure. Keep in mind, you’ll still have a Medical Gap to pay for the anaesthetist, and specialists may choose not to honour their Gap cover arrangements.  

We also recommend checking whether the insurer has Agreement Hospitals in your area. Having the joint replacement procedure done at an Agreement Hospital will mean no Hospital Gap. 

healthslips.com.au does not provide general or personalised advice. Your particular circumstances are likely to impact the accuracy, completeness and relevance of the information or results. Take this into account before making a decision and talk to an expert for financial advice.  

Trudie McConnochie

Writer and Researcher

Knowledge is power – that’s the guiding principle behind everything Trudie writes, and it’s a philosophy she brings to her work at healthslips.com.au. By breaking down complex information into easy-to-understand blogs and stories, she aims to empower Australians to make the best choices and an informed decision around private health insurance.

Trudie understands firsthand some of the complexity of private health insurance having moved to Australia from New Zealand and having to navigate a vastly different public healthcare system and health insurance structure.

Trudie holds a Bachelor of Communication Studies (journalism major) from the Auckland University of Technology.

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