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?
Answered by 19 licensed agents
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.
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.
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.
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.
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%
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.
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!
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.
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
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 .
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.
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.
