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?

Question

Lauren Hawkins · Accepted Answer

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/#

Answered by Lauren Hawkins on May 5, 2025

Agent Licensed in SC & CT

Answered by Lauren Hawkins Medicare Insurance Agent

Lt Col Tim Brown · Answer

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.

Answered by Lt Col Tim Brown on April 22, 2025

Broker Licensed in TN, AL, CO & 10 other states

Answered by Lt Col Tim Brown Medicare Insurance Agent

Norman Smith · Answer

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!

Answered by Norman Smith on March 26, 2025

Agent Licensed in FL & PA

Answered by Norman Smith Medicare Insurance Agent

Tasha Riggs · Answer

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.

Answered by Tasha Riggs on March 27, 2025

Broker Licensed in CO, AZ, HI & 10 other states

Answered by Tasha Riggs Medicare Insurance Agent

Nikki Rowland · Answer

You should not have any other out of pocket cost as long as you have met our yearly deductible.  2025 is $257

Joseph Bachmeier · Answer

Your knee replacement is covered. Medicare will cover 80% and your supplement will cover the other 20% after your $257 deductible

William Gray · Answer

Medicare plan G is the most comprehensive Medicare Supplement available today. 

Once you meet the 257$ deductible for part B your medicare supplement will cover your remaining cost of care at 100%. 

This is assuming you are on the G and not the HDG (the HDG has a 2870) then its 100% covered.

Edward Smith, ChFC, CRPS, AIF · Answer

It should cover everything that is considered medically necessary. You have your part B deductible, and it should cover the 20% that original Medicare doesn't cover. Check and see if your state allows for balance billing. My state does not. Balance billing is when the doctor or facility charges more than is allowed by Medicare.

Answered by Edward Smith, ChFC, CRPS, AIF on June 23, 2025

Broker Licensed in OH, GA, IN, KY & SC

Answered by Edward Smith, ChFC, CRPS, AIF Medicare Insurance Agent

Anthony Castelluccio · Answer

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.

Answered by Anthony Castelluccio on April 17, 2025

Agent Licensed in PA, DE, MD, NJ & VA

Answered by Anthony Castelluccio Medicare Insurance Agent

Robert Vaughan, R.Ph., MBA · Answer

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.

Answered by Robert Vaughan, R.Ph., MBA on May 7, 2025

Broker Licensed in CA, AZ, NM, NV & TX

Answered by Robert Vaughan, R.Ph., MBA Medicare Insurance Agent

Mark Cunningham · Answer

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.

Kathryn Zekas · Answer

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.

Answered by Kathryn Zekas on May 7, 2025

Broker Licensed in FL

Answered by Kathryn Zekas Medicare Insurance Agent

Melanie Baxter Black · Answer

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%

Answered by Melanie Baxter Black on April 7, 2025

Agent Licensed in TX

Answered by Melanie Baxter Black Medicare Insurance Agent

Nydia Flores · Answer

Hello 
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. 

Thank you
Nydia Flores

Robert Fracchia · Answer

Yes. After meeting your deductible your Medicare Supplement plan G would cover what Original Medicare doesn't cover

Tonya Bell · Answer

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.

Steven Bleicher · Answer

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.

Answered by Steven Bleicher on May 19, 2025

Broker Licensed in AZ

Answered by Steven Bleicher Medicare Insurance Agent

Timothy Brown · Answer

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.

Answered by Timothy Brown on May 31, 2025

Broker Licensed in PA, CT, DE & 15 other states

Answered by Timothy Brown Medicare Insurance Agent

Daintee Hurst Dietz · Answer

If you are going to a medicare allowed facility and Dr accept medicare patients and it’s fair and reasonable, if should be covered. Again need the details of procedure.

Becki Jennings · Answer

If you haven't paid your Part B annual deductible, you will be billed that amount. This year it is $257. If you HAVE paid your Part B deductible, you will likely not receive a bill. The provider will bill Medicare and your Plan G. There should not be any additional charges for that procedure.

Answered by Becki Jennings on June 7, 2025

Agent Licensed in MO

Answered by Becki Jennings Medicare Insurance Agent

Garrett Ball · Answer

Yes, it will be covered in full by Medicare and your Plan G. After the deductible is met, Medicare pays 80% and the Plan G pays the other 20%.

Fred Manas · Answer

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:
.
You'll need to pay the annual Medicare Part B deductible, which is $257 in 2025. 
20% Coinsurance:
.
Medicare will pay 80% of covered services, and you'll pay the remaining 20% (your coinsurance). 
Medigap Plan G Coverage:
.
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.

Steve Brauer · Answer

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".

Answered by Steve Brauer on May 7, 2025

Broker Licensed in AZ & CA

Answered by Steve Brauer Medicare Insurance Agent

Vachik Chakhbazian · Answer

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

Answered by Vachik Chakhbazian on April 17, 2025

Agent Licensed in CA, AL, AR & 22 other states

Answered by Vachik Chakhbazian Medicare Insurance Agent

Carol Thompson · Answer

It should cover it but I would reach out to your plan to Verify the coverage. The billing department of your insurance company can help you with this.

Toni Chavez · Answer

Good morning & Happy Sunday!

Since you have Plan G you should only have to pay the annual Part B deductible $240.  

Thanks,
Toni Chavez
Medicare Broker

Chuck Winslow · Answer

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.

Tony Merwin · Answer

In short, yes. You’ll need to fulfill your deductible but otherwise you’re covered including time spent in a skilled nursing facility to rehabilitate.

Fran Lovelace · Answer

On plan "G" if it is done outpatient, you will have the deductible.  If it is inpatient, you will not have a deductible.  As long as it is a Medicare covered service, it will then be covered in full.

Bob Nunn · Answer

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 .

Answered by Bob Nunn on April 11, 2025

Agent Licensed in FL, AL, AR & 36 other states

Answered by Bob Nunn Medicare Insurance Agent

Judi Norton · Answer

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.

Answered by Judi Norton on May 5, 2025

Agent Licensed in NM

Answered by Judi Norton Medicare Insurance Agent

Kimberly Griego · Answer

Yes, your Medigap Plan G will cover any and all Medicare-allowed charges once you have satisfied your annual Part B deductible (currently $257).

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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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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