I was already scheduled for total knee replacement when I took out my policy, will my supplemental plan G still pay?

Question

Lt Col Tim Brown · Accepted Answer

Yes it will.  I am making the assumption you enrolled during the enrollment period of turning 65.  During this Initial Election Period, you have no medical questions and they take you as you are.

James Carlson · Answer

If the surgery is after the effective date, the policy will pay the total cost of the operation.  
You have to schedule the surgery after the effective date.

Joshua Ruiz · Answer

Yes. Once the policy is issued it will pay secondary to any claims paid by medicare. If you enrolled in Plan G during your Medigap Open Enrollment Period (the 6 months after enrolling in Part B at 65+), no pre-existing condition limitations apply—your surgery would be covered.

Answered by Joshua Ruiz on May 22, 2025

Broker Licensed in NC, AL, AZ & 17 other states

Answered by Joshua Ruiz Medicare Insurance Agent

Fred Manas · Answer

Yes, Medicare Supplement Plan G will likely still pay for your scheduled total knee replacement, but with a potential pre-existing condition waiting period. While Medigap plans don't cover the cost of the surgery itself, they do help with out-of-pocket costs like deductibles, coinsurance, and excess charges. 
Explanation:
Medigap and Pre-existing Conditions:
Medigap policies, including Plan G, often have a waiting period for pre-existing conditions. This means they may not cover expenses for treatment of a condition you already had when you enrolled in the policy, for a certain period (usually 6 months). 
Waiting Period and Guaranteed Issue:
If you have a guaranteed issue right (meaning you're eligible to enroll in any Medigap policy without having to prove good health), the waiting period for pre-existing conditions doesn't apply, according to Medicare.gov. 
Creditable Coverage:
If you had at least 6 months of prior creditable coverage (like another health insurance policy), the waiting period for pre-existing conditions may be shortened, according to Cigna. 
Plan G and Knee Replacement:
Plan G, like other Medigap plans, helps cover the 20% coinsurance you'd owe after Medicare pays its share, as well as deductibles and other costs. It does not cover the full cost of the surgery itself. 
Medicare Part A & B:
Original Medicare (Part A and B) generally covers knee replacement surgery if it's deemed medically necessary. Part A covers inpatient hospital costs, and Part B covers outpatient procedures and surgeries. 
Plan G and Out-of-Pocket Costs:
Plan G will help reduce the out-of-pocket costs you'd have for your knee replacement, even if you have a pre-existing condition waiting period, according to Medicare.gov. 
In short: You can likely enroll in Plan G, and it will help cover some of your out-of-pocket costs for the knee replacement, but you may have a waiting period for pre-existing conditions before your Plan G covers expenses for treatment of your knee issue.

Marcie Barnes · Answer

If you are new to Medicare and didn't have to go through underwriting and were approved.  The answer will be yes.

If you did go through underwriting and failed to share this information you may want to speak with the insurance company.

You sign a contract stating the answers to the questions given were true.  One of the questions asked is if you have scheduled procedures not yet performed.

Linda Davies · Answer

Medicare Supplement plans, including Medigap Plan G, typically covers surgeries deemed medically necessary. However, if the surgery was scheduled before you enrolled in the Medigap plan, the coverage may depend on the specific terms of your Medigap plan and the circumstances of the surgery. It is essential to review your Medigap policy details and consult with your insurance provider to understand the coverage for your surgery.

Answered by Linda Davies on May 22, 2025

Agent Licensed in IL

Answered by Linda Davies Medicare Insurance Agent

Alaina Hunt · Answer

Yes, your Medicare Supplement Plan G should help pay for your knee replacement, even if you were already scheduled for surgery when you got the plan. These plans usually don’t have waiting periods or exclude things you already planned.

Just make sure your surgery happens after your Medicare started and that Medicare approves it. If you want to be sure, you can always double-check with your plan or Medicare.

Tony Merwin · Answer

Most likely, yes. However it may depend on how or when you enrolled in your Plan G. If you took the policy out during your Open Enrollment period with Guaranteed Acceptance then, yes. If otherwise then it's possible they could enforce a 6 month wait period for pre-existing conditions, but still unlikely. Generally a Medicare supplement carrier would not even issue the policy if they know you have a pending surgery verfiied by health underwriting.

Answered by Tony Merwin on May 22, 2025

Agent Licensed in TX, AR, AZ & 28 other states

Answered by Tony Merwin Medicare Insurance Agent

I was already scheduled for total knee replacement when I took out my policy, will my supplemental plan G still pay?

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I was already scheduled for total knee replacement when I took out my policy, will my supplemental plan G still pay?

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