Joint replacement surgery in Australia is performed in the private health system. Understanding how private health insurance, Medicare rebates, and surgeon fees interact helps patients plan ahead. This page explains the structure of costs — and how to get a written estimate before committing to any procedure.
Private health insurance
Total hip and knee replacement surgery is performed at Eastwood Private Hospital and Calvary Adelaide Hospital — both private facilities. To access these hospitals as a private patient, you will need appropriate private health insurance with hospital cover that includes orthopaedic surgery.
Not all hospital cover policies include joint replacement. Policies at the lower tiers ("Basic" or "Bronze") often exclude or restrict orthopaedic procedures. Before booking a consultation, it is worth confirming with your fund that your policy covers:
- Orthopaedic surgery (joint replacement)
- The specific hospitals where Dr Liew operates (Eastwood Private Hospital and Calvary Adelaide Hospital)
- Any applicable waiting periods — most funds impose a 12-month waiting period for pre-existing conditions
If you are unsure about your level of cover, call your fund directly and ask specifically about joint replacement surgery and any applicable hospital excess.
Medicare rebates
Medicare provides a partial rebate for surgical procedures listed on the Medicare Benefits Schedule (MBS). Every eligible hip and knee replacement procedure has an assigned MBS item number. Medicare reimburses 75% of the Schedule Fee for that item when you are admitted as a private patient in a private hospital.
Your private health fund pays an additional benefit — typically the remaining 25% of the Schedule Fee, depending on your policy. The combined Medicare and health fund rebate partially offsets the surgeon's fee, but does not typically cover it in full.
"Understanding your entitlements before surgery — not after — is the most important step a patient can take. Our rooms are always available to help you understand your specific situation before you commit to anything."
— Dr Chien-Wen Liew, Orthopaedics 360Gap fees and out-of-pocket costs
The gap is the difference between the total fee charged and the combined rebate from Medicare and your health fund. It represents your out-of-pocket cost for the surgeon's component of the procedure.
Several factors influence the size of the gap:
- The surgeon's fee for the specific procedure performed
- The MBS item number assigned to that procedure
- Your health fund and the benefit level it pays above the Medicare rebate
- Whether your fund has a "no-gap" or "known-gap" arrangement with the surgeon (this varies by fund)
To obtain an estimate of your out-of-pocket cost, contact Orthopaedics 360 on (08) 7077 0158 with your health fund name and membership number. We can provide a written fee estimate that details the expected gap for your specific procedure before you proceed.
Call Orthopaedics 360 on (08) 7077 0158 with your: private health fund name, membership number, and the procedure discussed at your consultation. We will provide a written estimate of the surgeon's fee and the expected Medicare and health fund rebates.
Other costs to be aware of
The surgeon's fee is one component of the total cost of joint replacement surgery. There are several other costs to understand before proceeding:
Hospital costs — Theatre fees, nursing care, and overnight accommodation at Eastwood Private Hospital or Calvary Adelaide Hospital are billed separately by the hospital. These are generally covered by your private health insurance, subject to any applicable hospital excess on your policy. Check with your fund about the excess amount before admission.
Anaesthetist fees — Your anaesthetist charges independently from the surgeon. You will typically receive a call from the anaesthetist before surgery to discuss their fees and what rebates apply. Anaesthetist fees can carry a gap depending on your fund and the anaesthetist's billing arrangements.
The joint implant (prosthesis) — The implant used in your surgery is listed on the Australian Government's Prostheses List. Private health funds with hospital cover are required to cover approved prostheses at the listed benefit — generally meaning no additional out-of-pocket cost for the implant itself, provided your policy covers orthopaedic surgery.
Pre-operative imaging and consultations — X-rays, CT scans, and pre-operative assessments may attract fees from radiology providers and your GP. Medicare rebates apply to most of these items.
Physiotherapy — Post-operative rehabilitation is important to your recovery. Most physiotherapy costs are not covered by Medicare (unless accessed through a chronic disease management plan) but may attract a rebate from your health fund's extras cover if applicable.
Steps to understanding your costs
Before surgery, we recommend working through the following steps to avoid surprises:
- 1Check your policy. Call your private health fund and confirm you have hospital cover that includes orthopaedic surgery, that your chosen hospitals are covered, and whether any waiting periods apply.
- 2Ask about your excess. Most policies have a hospital excess — an amount you pay when admitted. Confirm the amount with your fund before your admission date.
- 3Request a fee estimate. Once you have been seen by Dr Liew and a procedure has been discussed, contact Orthopaedics 360 with your fund details. We will provide a written estimate of the expected gap for your surgeon's component.
- 4Confirm with your fund. Once you have your written estimate, provide the MBS item numbers to your fund. They can confirm the exact rebate your policy pays and calculate your final out-of-pocket cost.
- 5Enquire about the anaesthetist. The anaesthetic team will contact you separately before surgery. Ask about their gap fees at that time.