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.
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, is currently $1,577.30, with Medicare’s 75% rebate coming to $1,183.00. If your surgeon charges above that 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
The table below compares the four main pathways Australians consider for a knee replacement. For a line-by-line breakdown of every fee involved, see the full cost breakdown of a knee replacement in Australia.
| Pathway | What Medicare Covers | Typical Out-of-Pocket Cost | Typical Wait |
| Public hospital patient | Full cost: surgeon, hospital, prosthesis | $0 | Median 242 to 265 days, longer in some states |
| Private hospital, insured | 75% of the MBS surgeon fee only | Approx. $1,000 to $5,000+ in gap fees | 4 to 6 weeks |
| Private hospital, self-funded | 75% of the MBS surgeon fee only | Approx. $25,000 to $35,000 total | 4 to 6 weeks |
| Treatment in Thailand | Not covered, Medicare doesn’t apply overseas | From AU$13,000 standard, AU$20,000 MAKO robotic | 2 to 4 weeks from consultation |
Medicare’s 75% rebate applies to the Medicare Benefits Schedule fee, not to what your surgeon actually charges. Many orthopaedic surgeons bill above the schedule fee, which is why private patients can still face a gap even with insurance.
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, and more recent 2024-25 figures put the median at 242 days for the general population, and higher again for First Nations patients. Roughly one in four patients waited more than 12 months for their surgery. Knee replacement is consistently one of the longest waits on the elective surgery list, well above the overall median wait of around 45 days for all procedures combined.
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.
If You Don’t Have Private Health Insurance
Without private cover, your realistic choices are the public waiting list, or self-funding a private admission in full. Self-funded knee replacement in Australia typically runs from $25,000 to $35,000, covering the surgeon, anaesthetist, hospital stay, and prosthesis, with Medicare’s rebate covering only a small fraction of that total.
Taking out private health insurance now is rarely a quick fix either. Most funds apply a 12-month waiting period for joint replacement as a pre-existing condition, so it isn’t a practical option if you need surgery soon. A few practical ways to reduce your out-of-pocket cost within Australia:
- Ask about no-gap or known-gap arrangements: some funds run partner programs with orthopaedic surgeons who don’t charge above the schedule fee.
- Confirm your policy actually includes joint replacement: and check whether your 12-month waiting period has been served.
- Check the prosthesis against the government’s Prescribed List of prostheses, since some premium implants carry a gap your fund won’t fully cover.
- Get a written quote from your surgeon and anaesthetist before you book, so there are no surprises on the day.
Treatment Options Outside Australia
Medicare doesn’t extend to treatment performed overseas, so if you’re weighing that option, the comparison isn’t Medicare versus Thailand, it’s the total Australian bill and wait against a fixed, all-inclusive overseas price and a much shorter timeline.
Medidash Global connects Australian patients with two JCI-accredited orthopaedic hospitals in Bangkok. Phyathai 2 International Hospital offers standard knee replacement from AU$13,000, while KDMS Hospital, Thailand’s first dedicated bone and joint hospital, offers MAKO robotic-assisted knee replacement from AU$20,000. Both figures are typically arranged well within a four-week window from initial consultation to surgery, compared with the months-long public wait list at home. For a full look at how the process works end to end, see our complete guide to knee and hip replacement abroad, and if you’re weighing robotic assistance against a conventional approach, our guide to choosing between conventional and MAKO robotic knee replacement covers the differences in recovery, precision, and cost.
Medidash Global’s role is to coordinate the parts of the process that are hardest to manage from overseas, matching you with the right surgeon, arranging pre-admission tests, and organising accommodation and airport transfers so the trip itself doesn’t add to the stress of surgery.
Recovery logistics matter too when you’re travelling for surgery. If you’re planning the trip around work or family commitments, our guide on how soon you can fly home after surgery sets out realistic timeframes so you can plan your return flight with confidence.
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.
Talk to Someone About Your Options
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. Speak with our patient care team for a personalized cost and timeline comparison based on your situation.
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. 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 waiting for a knee replacement in Australia?
Around 242 to 265 days for half of public patients to be admitted, according to recent 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.