Yes, Medicare covers knee replacement surgery in Australia, but how much it covers depends entirely on which pathway you take. As a public patient in a public hospital, Medicare pays for the whole procedure, the surgeon, the anaesthetist, the hospital stay and the prosthesis, and you won’t receive a bill. Choose the private system instead, and Medicare only contributes toward part of the surgeon’s fee. For many Australians facing a public wait list of eight months or longer, that gap between “covered” and “affordable and fast” is exactly where private health insurance, self-funding, or treatment overseas, including knee replacement surgery in Thailand, comes into the picture. This guide breaks down exactly what Medicare pays for, what it doesn’t, and what your realistic options are.
Quick answer
Public patients pay nothing. Private patients (insured or self-funded) get Medicare’s 75% rebate on the surgeon’s MBS fee only, not the hospital, theatre or prosthesis costs. Treatment overseas, including in Thailand, isn’t covered by Medicare at all.
How Medicare Covers Knee Replacement Surgery
There are two distinct pathways for a knee replacement in Australia, and Medicare treats them very differently.
- Public patient in a public hospital: Medicare covers the entire cost, including the surgeon, anaesthetist, hospital accommodation and the prosthesis. You don’t choose your surgeon, your hospital, or your admission date, and you go onto the public elective surgery waiting list.
- Private patient, whether insured or self-funded: Medicare pays 75% of the Medicare Benefits Schedule fee for the surgeon’s and anaesthetist’s services only. It does not pay for hospital accommodation, theatre fees, or the prosthesis. Those costs are met by your private health insurer, or by you if you’re self-funding.
To put a number on it, the Medicare Benefits Schedule fee for a standard total knee replacement, listed under item 49518, was set at $1,450.55, with Medicare’s 75% rebate coming to $1,087.95, in the MBS Online orthopaedic surgery factsheet effective 1 March 2024. MBS fees are indexed periodically, so check MBS Online for the current figure before you budget. If your surgeon charges above the schedule fee, which is common in private orthopaedic care, the difference becomes your out-of-pocket gap on top of any hospital and prosthesis costs.
This distinction catches a lot of people out. Many Australians assume that because they hold private health insurance, Medicare and their fund together cover everything. In practice, Medicare’s role in a private admission is limited to the medical, not the hospital, side of the bill.
What You Actually Pay: Public, Private and Overseas
As a public patient, Medicare covers the whole procedure and you pay nothing. As a private patient, Medicare rebates 75% of the Medicare Benefits Schedule fee for the surgeon’s and anaesthetist’s services only, so hospital, theatre and prosthesis costs fall to your health fund or to you, and any surgeon charge above the schedule fee adds to your gap. For the dollar figures behind each pathway, see our guide to knee replacement cost in Australia.
The Real Cost of Waiting for a Public Knee Replacement
The zero-dollar price tag of the public system comes with a trade-off: time. According to AIHW’s national elective surgery data, half of public patients waited 265 days for a total knee replacement in 2023-24, one of the longest waits of any common procedure, well above the roughly 45-day median wait across all elective surgeries combined. Roughly one in four knee replacement patients waited more than 12 months. AIHW’s most recent national release shows overall median waits holding broadly steady into 2024-25, though a knee-specific figure for that year was not yet published at the time of writing; check AIHW’s Hospitals platform for the latest breakdown.
For someone in chronic pain and losing mobility, that wait isn’t just an inconvenience. It’s the main reason so many Australians start looking seriously at private health insurance, self-funding, or treatment abroad. Our guide on how long you can wait for a knee replacement in Australia breaks the state-by-state picture down further.
Does Medicare Cover Robotic (MAKO) Knee Replacement?
Yes, in the sense that the core surgery is still rebated. Medicare pays the same 75% rebate on item 49518 regardless of whether your surgeon uses conventional instruments or a robotic-arm assisted system such as MAKO; the MBS item describes the procedure, not the technology used to perform it. What Medicare does not separately rebate is the robotic platform itself: the CT-based planning, software and system usage fees that come with robotic assistance are typically billed as an additional private cost, whether you have surgery in Australia or choose a robotic-assisted knee replacement in Thailand.
Is There an Age Limit for Medicare-Funded Knee Replacement?
No. The MBS item for total knee replacement has no age restriction written into it; eligibility comes down to clinical need, not a birthday. In practice, surgeons weigh a patient’s overall fitness for surgery and anaesthesia, and very elderly or medically complex patients may need additional pre-operative assessment, but there is no cut-off age that disqualifies someone from a Medicare-rebated knee replacement, whether they’re a public or private patient.
What About Hip Replacement?
The same two-pathway structure applies to hip replacement. Public patients have the full cost covered by Medicare through the public system; private patients get the 75% MBS rebate on the surgeon’s fee for the equivalent hip arthroplasty item, with hospital, theatre and prosthesis costs met separately. Our hip replacement in Thailand page covers pricing and the process for patients weighing up the same public-versus-private-versus-overseas decision for a hip.
Arthroscopy, Meniscus, ACL and Gel Injections: What Does Medicare Cover?
Medicare rebates most medically necessary knee procedures under their own MBS items when a surgeon determines they’re clinically indicated: diagnostic and therapeutic arthroscopy, meniscus repair or partial meniscectomy, and ACL reconstruction all have dedicated item numbers, separate from the total knee replacement item above. Knee gel injections, also called viscosupplementation or hyaluronic acid injections, sit differently: they are not routinely funded by Medicare and are usually an out-of-pocket cost, so confirm this directly with your specialist rather than assuming coverage. As with the knee replacement item itself, ask your surgeon or check MBS Online for the exact item number and current fee that applies to your specific procedure.
If You Don’t Have Private Health Insurance
Without private cover, your realistic choices are the public waiting list, where Medicare covers the full cost, or self-funding a private admission, where Medicare’s rebate covers only part of the surgeon’s fee. Taking out cover now is rarely a quick fix because most funds apply a 12-month waiting period for joint replacement, which our guide to knee replacement without private health insurance explains in full.
Weighing up the public list against surgery abroad?
Speak with a Medidash Global care coordinator about a realistic cost and timeline comparison for your own situation, no obligation.
Treatment Options Outside Australia
Medicare doesn’t cover treatment performed overseas, so patients who go abroad pay the overseas hospital directly and receive no Medicare rebate for that care. Medidash Global arranges knee replacement in Thailand at two JCI-accredited Bangkok hospitals, with pricing and inclusions on the treatment page.
Choosing the Right Procedure for Your Knee
Not every patient needs the same procedure. Some need only one compartment of the knee replaced rather than the whole joint, which affects recovery time, cost and eligibility. Our comparison of total vs partial knee replacement explains which patients are usually suited to each option.
Whichever pathway you choose, public, private, or overseas, preparation improves your outcome. Our pre-surgery checklist and exercise guide covers what to organise at home, what to ask your surgical team, and the prehabilitation exercises that tend to shorten recovery.
Book a Private Consultation with Medidash Global
Whether you’re weighing the public wait list, a private admission, or treatment abroad, it helps to see the real numbers side by side before deciding. Medidash Global’s care coordinators work with Phyathai 2 International Hospital and KDMS Hospital in Bangkok, both JCI-accredited, to give Australian patients a clear, itemised comparison against their own public or private quote.
- A personalised cost and timeline comparison based on your own diagnosis and location
- Clarity on standard vs MAKO robotic pricing, with implant inclusion stated up front
- Coordination of surgeon matching, pre-admission tests, accommodation and airport transfers
- A realistic recovery and flight-home plan built around your own schedule
Ready to compare your options?
Book a private, no-obligation consultation with a Medidash Global care coordinator for a personalised cost and timeline comparison for your knee replacement.
Frequently Asked Questions About Medicare and Knee Replacement Coverage in Australia
Does Medicare cover the full cost of a knee replacement?
Only if you’re treated as a public patient in a public hospital. In that case, Medicare covers the surgeon, hospital stay and prosthesis in full. As a private patient, Medicare covers only part of the surgeon’s fee.
How much does Medicare rebate for knee replacement surgery?
Medicare rebates 75% of the Medicare Benefits Schedule fee for the surgeon’s and anaesthetist’s services when you’re treated privately, currently $1,087.95 on the $1,450.55 schedule fee for item 49518 (check MBS Online, as this is indexed periodically). It does not rebate hospital, theatre or prosthesis costs in the private system.
Does Medicare cover MAKO robotic knee replacement?
Medicare rebates the core knee replacement item regardless of whether it’s performed conventionally or with robotic assistance. The robotic technology itself, including software and platform fees, is not separately rebated and is usually an added private cost.
How long is the public wait for a knee replacement in Australia?
265 days for half of public patients in 2023-24, according to AIHW data, with roughly a quarter of patients waiting more than a year. Wait times vary by state and hospital.
Can I use Medicare for knee replacement surgery overseas?
No. Medicare benefits apply only to treatment provided in Australia. Patients who choose treatment abroad, including in Thailand, pay the overseas hospital directly and don’t receive a Medicare rebate for that portion of care.
Is knee replacement in Thailand safe for Australian patients?
Medidash Global’s partner hospitals, Phyathai 2 International Hospital and KDMS Hospital, are internationally accredited facilities with dedicated orthopaedic teams and established international patient programs, including coordination for Australian patients from consultation through recovery.