I'm on Medigap Plan G, and I'm curious how my upcoming knee replacement surgery will be billed. Does the plan cover it all after my deductible?
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Yes. As long as the facility where you have the surgery accepts Medicare assignment, you will only be responsible for the Part B annual deductible ($257 for 2025). Once you pay the Part B annual deductible, Medicare will pick up 80% of the remaining bill, and your Medigap Plan G will pick up the other 20%. https://medicareagentshub.com/#
If you’ve already met your deductible then you’re covered at 100%. If you have not met your deductible, then it will be covered after the deductible at 100%. If the facility you go to says “if you pay this much now, we cut this much off your bill”. Do not do this. Tell them to just bill the insurance. If you get a bill in the mail, don’t just pay it. Providers bill patients before insurance even knows they have a claim and it’s often more than you would owe if you hadn’t met your deductible. Call the company billing you. Tell them you have a Plan G and you won’t owe what they’re billing and wait for an Explanation of benefits before paying what would be your deductible assuming you have not already met your deductible. You’ll owe nothing if you’ve already met it.
Yes!! Once you meet the deductible you will have 100% as long as the providers you are seeing accept Medicare. Physical Therapist may not may not take Medicare so make sure they are contracted with them.
Basically that is correct. Any Part B service which will include a knee replacement or PT afterwards should be covered by your G plan, but the big piece here is if Medicare approves the service. If it's done experimental knee replacement, Medicare most likely will not approve that service and your G plan will not cover it. But for the most part, you really should not see any bills after your deductible for a knee replacement.
Yes, Medicare Supplement Plan G will cover all Medicare-covered costs associated with a knee replacement, except for the Part B deductible. If the procedure is covered by Medicare and deemed to be medically necessary, your Medigap Plan G will cover all costs with the exception of your Medicare Part B deductible.
Medigap Plan G is a comprehensive supplement to Original Medicare (Parts A and B). It provides extensive coverage for various out-of-pocket costs that Medicare does not fully cover.
Medigap Plan G covers all costs not paid by Original Medicare except for the Medicare Part B deductible. In 2025, the Part B deductible is $257. This means that before Medigap Plan G begins to cover your knee replacement surgery, you will need to pay this deductible out of pocket, if you have already met the deductible for 2025 there will be no additional out of pocket expense for Medicare covered procedures.
The billing process for your knee replacement surgery will generally follow these steps:
• Your healthcare providers will submit claims to Medicare for the services rendered.
• Medicare will process the claims and pay its share of the approved amounts.
• The remaining eligible expenses will be forwarded to your Medigap Plan G insurer, which will then pay its share directly to the providers.
Once you have paid the Medicare Part B deductible, Medigap Plan G will cover the remaining costs of your knee replacement surgery, ensuring you have minimal out-of-pocket expenses. Always check with your healthcare provider and Medigap insurer to confirm specific coverage details and to understand exactly what to expect during the billing process.
Yes. Generally, a Medigap Plan G will pay everything after you have met your Medicare Part B deductible, which for 2025 is $257. So the office will bill Medicare, and Medicare can see if you have already met your deductible or not. If not, you will owe the $257 first, and then your supplement will pay the rest.
The only out-of-pocket expense you should have on a Medicare Supplement Plan G, apart from your monthly premium, is your Part B Medicare annual deductible. After your annual Part B deductuble is met, anything hospital or doctor related is covered at 100%
Medigap Plan G is a supplemental insurance and considered secondary insurance. The bill will generally go to the primary insurance first, which will be Medicare. Medicare will cover at 80% of the Medical expenses. The remaining balance will be sent to Medigap Plan G, which will cover the outstanding 20% balance. You will be responsible for any copays or deductibles.
As long as your Medicare covers it then your supplement will pick up everything after the deductible. Anything Medicare does not pay. The supplement will not pay.
Plan G is the most popular Medigap plan you can acquire. Remember that the ratio of 80/20% ALWAYS comes into play. Part A is for IN-patient hospital services. That's your Primary insurance, paying 80% while the balance of 20% will be paid by your Med. Supplement. Thus, here are your two theoretical examples: A) like the above, the knee surgery is performed in a hospital. Part A pays the 80% of all surgical charges while the Supplement picks up all the rest except for the one-time per year (!) Part B deductible of $257.00. If you already have met that amount, no additional funds are your responsibility. B) Though rare, if this same operation is done in an outside surgical center, (outpatient!) the 80% is paid by Part B and the remainder is again paid by the Medigap plan.
All Medicare approved services are covered under a Plan G after the annual deductible is met. Keep in my, Original Medicare Part A & Part B is your primary insurance and that is who the doctor/hospital bills first. The supplement pays the 20% of the cost that Medicare doesn’t pay for after the annual deductible. No surprise bills afterwards and the biggest take away is that there are NO prior authorization hurdles to jump over.
Yes! As a Plan "G" Supplement holder, as long as you continue to have original Medicare A and B, pay your Part B and your supplement premiums, your only obligation to medical bills will be the $257 Part B Deductible, and you should not see a bill again for the rest of the year regardless of any other medical needs, outside of Long Term Care. If you do not have an agent who can answer these questions, you should find one! That's what the Agent should be paid to do - service AFTER the sale!
With Medigap Plan G, you'll pay the Medicare Part B deductible and the 20% coinsurance on covered services, but the plan will then cover the remaining costs for your knee replacement surgery. Plan G essentially covers the "gaps" in Original Medicare coverage, helping with deductibles, coinsurance, and copayments.
Here's a more detailed breakdown:
Medicare Part B Deductible:
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You'll need to pay the annual Medicare Part B deductible, which is $257 in 2025.
20% Coinsurance:
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Medicare will pay 80% of covered services, and you'll pay the remaining 20% (your coinsurance).
Medigap Plan G Coverage:
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Once you've met the deductible and paid your coinsurance, Medigap Plan G will pay the remaining costs for Medicare-approved services.
In essence, Medigap Plan G helps bridge the gap between Original Medicare's coverage and your overall healthcare costs. It covers the coinsurance and copayments that Original Medicare doesn't, and helps with deductibles.
For a more personalized explanation, it's always a good idea to consult with your Medigap insurer or a Medicare advisor to understand how Plan G specifically covers your situation.
Thanks for asking!!...Your MediGap or Medicare Supplement SHOULD cover all or most of the cost of your knee replacement surgery. There should not be any copays associated with this procedure, as long as it is considered "medically necessary" and done by physicians that accept Medicare "Assignment". That means they accept what Medicare pays them for specific services and will not bill above and beyond that. A doctor can accept Medicare patients BUT not accept Medicare "assignment", meaning they can charge patients up to 15% above what Medicare pays them. Fortunately for you, Plan G PAYS the extra 15%, called Medicare "excess fees".
Yes, Medigap Plan G will help cover your knee replacement surgery costs after you meet your Part B deductible. Once you've met the deductible, Plan G will cover the remaining out-of-pocket costs, including copayments and coinsurance
Great question — here's how it works with Medigap Plan G:
Medigap Plan G covers everything that Original Medicare covers except the Part B annual deductible (which is $240 in 2025). So for your knee replacement:
1. Medicare Part A will cover your hospital stay and related inpatient costs.
2. Medicare Part B will cover the doctor fees, outpatient surgery costs, and physical therapy.
Once you've paid your $240 Part B deductible, Plan G pays 100% of the remaining Medicare-approved charges, including:
Hospital costs
Surgeon's fees
Anesthesia
Outpatient rehab
Durable medical equipment like a walker
So yes — after your deductible is met, your Plan G will cover the rest of the knee replacement surgery as long as it's Medicare-approved.
Plan G has a once a year 250 deductible than as long as it is a Medicare covered expense you will be covered , Always ask do you accept Medicare , is this a Medicare covered procedure and what will be my portion before the operation or service , they have to inform you by law .
On a Medigap Plan G, there is a $257 annual deductible that must be met before the plan will pay the remaining balance. You will receive a statement from Medicare indicating that you have either met your deductible or you have not met your deductible. If you have met the annual deductible, the plan pays the remainder for the rest of the year. If you have not met the deductible, you will need to pay the facility where the services occurred up to the amount of the deductible.