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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2 .Part A or Part B Coverage:
If the surgery is an inpatient procedure (requires an overnight hospital stay), Medicare Part A covers the hospital costs. Plan G will cover your Part A deductible and any coinsurance.
If the surgery is an outpatient procedure (most knee replacements are now outpatient), Medicare Part B covers the surgeon's fees, facility charges, and other related services. You are responsible for meeting the annual Part B deductible.
3. Medigap Plan G Pays Second: After Medicare pays its portion, your Medigap Plan G policy kicks in to cover the remaining costs (the "gaps"). Plan G covers the 20% coinsurance that Original Medicare leaves you responsible for once you meet the Part B deductible.
4. Minimal Out-of-Pocket Costs: Once you've paid your annual Part B deductible (which is $257 in 2025), Plan G covers 100% of all remaining Medicare-approved Part B charges and all Part A deductibles and coinsurance. This means your additional out-of-pocket expenses for the surgery and recovery should be minimal or non-existent, aside from your monthly Medigap premiums.
Answered by John Becker on December 1, 2025
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Here's what to expect:
Hospital stays (Part A): If you're admitted as an inpatient, Medicare covers most costs, and Plan G covers the Part A deductible and coinsurance.
You pay $0 for the hospital stay.
Surgery, surgeon, anesthesia (Part B): These are billed under Part B. You’ll pay the $240 Part B deductible (for 2024) and then Plan G picks up the remaining 20% coinsurance.
You pay only the $240 deductible—nothing more.
Rehab and physical therapy: Whether done at home, outpatient, or in a facility, these are usually covered under Part B. Plan G will cover these costs after you meet the deductible.
In total:
As long as your providers accept Medicare, your only out-of-pocket cost for the entire surgery and recovery will be $240, the annual Part B deductible. After that, Plan G takes care of the rest.
You're in an excellent plan for major procedures like this. Let me know if you’d like help checking if your providers accept Medicare or reviewing expected costs!
Contact us, we can help
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Once you meet the 257$ 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.
Answered by William Gray on May 29, 2025
Broker Licensed in FL, GA, ID & 9 other states
So when I came across this question, I definitely had to make a quick video because it's a pretty simple answer. The question is, I'm on a Medigap Plan G, and I'm curious how my upcoming knee replacement surgery will be billed. Does the plan cover it after all? Does a plan cover it all after my deductible?
The answer to that is yes. If you are getting this surgery done at a Medicare-approved facility and it is medically necessary, the only thing you have to pay for with a Medicare Plan G is a $283 deductible for this year. After that, you won't pay anything.
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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.
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John
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at texting. You do have the option to contact me if you choose, and I would be honored to
communicate with you if you do. Who knows, we might just have a valuable conversation.
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Ideally you should be check in to the facility in the morning and home by dinner. Including walking with a walker. Your Medicare part B ($283 Deductible) Which is not paid by plan G, then Medicare should pay 80% and Plan G will pay 20%. This includes the surgery center, Surgeons fees and the anesthesiologist. Some Surgeons use a robot new technology and that may not be covered by Medicare Part B and so your Supplement G will not be paying any of the as it is on out-of-pocket personal cost. If Medicare Does pay, then your supplement will of course supplement the balance.
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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.
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Medicare will cover your knee replacement if it is deemed as a necessary step.
If your knee replacement is done at an inpatient hospital., Medicare part A will cover the cost.
Plan G will cover the $1,676 deductible.
Most likely this would be the process. If you get it done at outpatient, not having to stay overnight, you will be responsible for B deductible in plan B, which for this year is $257.00
Answered by Rodolfo Rojas on June 30, 2025
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Anything NOT covered by medicare - if you need custodial care in a skilled nursing facility (not covered) vs. inpatient rehabilitation (covered), for example, would be your responsibility.
But in most cases, once you’ve paid the deductible, you’re covered for the rest.
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Answered by Adam Ernst on February 1, 2026
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Since you have Plan G you should only have to pay the annual Part B deductible $240.
Thanks,
Toni Chavez
Medicare Broker
Answered by Toni Chavez on June 8, 2025
Broker Licensed in AZ, CA, NM, NV & UT
If your knee replacement will occur as an Inpatient Hospital procedure, your plan G should bill Medicare under Part A and your Medigap Plan G, as such, will cover your Hospital Benefit Period Deductible with no out of pocket costs to you.
If the procedure will occur as an outpatient procedure under Part B, then you will be responsible for the $283 Part B Deductible. The remaining 20% coinsurance should be covered by your Medigap Plan G.
Answered by William Murray on February 2, 2026
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Answered by Blaine Shipe on October 12, 2025
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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.
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your provider can give you an estimate of how the coverage will work.
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After your deductible, Medicare will pay first and then your Plan G will pay the rest. So once you meet your deductible, then all procedures are covered.
Answered by Sue Mendoza on November 9, 2025
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Answered by Gina Pranzitelli on February 2, 2026
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Part A hospital coinsurance (and up to 365 extra hospital days)
Part B coinsurance/copays
Skilled nursing facility coinsurance
Blood (first 3 pints)
Part A hospice coinsurance/copays
Excess charges (when doctors charge more than Medicare’s approved amount)
Answer: it will cover the charges billed after approved by Medicare and after deductible has been met.
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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
Answered by Nydia Flores on May 12, 2025
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Tags: Coverage Medicare Supplement
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