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

Question

Joshua Ruiz · Accepted 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 & 22 other states

Answered by Joshua Ruiz Medicare Insurance Agent

Gary Church · Answer

Here's a good question. Somebody says, "I'm scheduled for knee replacement. When I took out my policy, which is a Medicare supplement plan G, will it still pay?" Yes, as long as the procedure you're having is medically necessary, and a knee surgery probably is medically necessary. Medicare is going to cover your supplement. Your plan G is going to cover that 20% that you'd be responsible for. But I understand there is a part B deductible that you will be responsible for that calendar year. So again, yes, it will. Your knee replacement will be covered by Medicare, and your Medicare supplement plan G will pick up that portion. Again, your responsibility is that part B deductible at the time.

Again, the best thing to do is to sit down with your Medicare agent or a licensed Medicare agent to understand what your options are. Hopefully, that answers your question. Thank you.

Again, the best thing to do is to sit down with your Medicare agent or a licensed Medicare agent to understand what your options are. Hopefully, that answers your question. Thank you.

Daniel Brechin · Answer

Yes, your procedure will still handle.  Your cost will depend on the Medicare Supplement coverage.   The plan is obligated to handle this cost.

Lt Col Tim Brown · 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.

Terri Reagin · Answer

Provided that you did so during an "open enrollment" or "guarantee issue" time frame then YES your supplement plan will pay for a scheduled surgery, provided it is approved.

Christopher Boyd · Answer

Medicare and Medicare Supplements will pay for all traditional outpatient medical treatments as long as the provider accepts Medicare Assignment. The patients responsibility is the Annual Part B Deductible before Medicare will cover the remaining charges for Plan G.

Answered by Christopher Boyd on October 14, 2025

Agent Licensed in IN, KY, MI, OH, PA & TN

Answered by Christopher Boyd Medicare Insurance Agent

Edward Smith, ChFC, CRPS, AIF · Answer

Yes, once you are approved and your policy is in force, there should be no limitations on something like that.

Ronnie Robinson Jr · Answer

Were you enrolled under a guaranteed issue situation? Since you are not our client, it's challenging to answer this correctly without knowing the background, and it should be addressed by the agent who enrolled you in Plan G.

Answered by Ronnie Robinson Jr on November 3, 2025

Broker Licensed in FL, AL, GA & 9 other states

Answered by Ronnie Robinson Jr Medicare Insurance Agent

Clarence &quot;Mark&quot; Christiansen · Answer

Medicare supplement plans will cover all Medicare-approved services and will pay after Medicare. Plan G means you will be responsible for an annual outpatient deductible, currently set at $ 256 in year 2025. If your total knee replacement involves an in-patient hospital stay, Medicare will be primary, your Plan G will pay after Medicare and you will have $ 0 (zero) out of pocket costs. Good luck with it!

Answered by Clarence "Mark" Christiansen on November 5, 2025

Agent Licensed in WI, AZ, CA & 16 other states

Answered by Clarence "Mark" Christiansen Medicare Insurance Agent

Steven Lovell · Answer

During the Medigap Open Enrollment Period: If you enrolled in your Plan G during your Medigap Open Enrollment Period (the 6-month period that starts the first month you have Medicare Part B and are age 65 or older), the insurance company cannot deny coverage or charge you more based on a pre-existing condition, like your knee condition. However, they may impose a pre-existing condition waiting period of up to 6 months. This means that while your policy won't be denied, the benefits related to the knee replacement might be delayed for that period. Original Medicare will still cover its portion during this waiting period, and your Plan G would cover costs for new conditions

Answered by Steven Lovell on June 10, 2025

Broker Licensed in GA, AL, CA & 11 other states

Answered by Steven Lovell Medicare Insurance Agent

Jacqueline Proffit · Answer

Whether your Medicare Supplement Plan G will pay for a scheduled knee replacement depends primarily on when you enrolled and your prior insurance history. Under most circumstances, if the surgery takes place after your policy's effective date, it will be covered. 
Here is how the timing and rules work:
1. The "Open Enrollment" Rule If you bought your Plan G during your Medigap Open Enrollment Period (the 6-month window starting the month you turn 65 and enroll in Part B), the insurance company cannot deny you coverage or refuse to pay for a pre-existing condition, even if a surgery was already on the books. Verdict: Your surgery should be covered if you enrolled during this one-time window.
2. The "Creditable Coverage" Factor Even if you are in your Open Enrollment period, an insurer could technically impose a pre-existing condition waiting period of up to 6 months if you did not have "creditable coverage" leading up to your new policy. If you had insurance: If you had at least 6 months of continuous health coverage (like an employer plan or a different Medigap policy) with no gap longer than 63 days, the waiting period is usually waived. If you had no insurance: You might have to wait up to 6 months before the supplemental plan pays its portion for that specific condition.
3. Original Medicare Still Pays It is important to remember that Original Medicare (Parts A and B) has no waiting periods for pre-existing conditions. Even if your Plan G has a waiting period, Medicare will still pay its 80% of the approved costs. The Plan G would only be "missing" for its portion (the 20% coinsurance and the Part A hospital deductible) during that waiting period.

Steven Whetstine · Answer

It depends on your scenario.  

If you had already scheduled your knee replacement prior to taking out your policy and you enrolled during open enrollment or a guaranteed issue period, then there was no underwriting and no wait for preexisting conditions.  After original Medicare pays for Part A (Hospital) and Part B (Medical), the Plan G would pick up the remaining costs except for the Part B deductible.

If you took out the policy and it was not the open enrollment or a guaranteed issue period, medical underwriting would have applied.  Original Medicare will still cover its share.  As far as the Medicare Supplement Plan G, there would have been some disclosures included within the policy.  Many insurance carriers would not have covered the knee replacement.  Generally, they ask for you to keep coverage and contact them after the knee replacement.  Some insurance carriers may impose a preexisting condition waiting period and may not cover the costs associated with the knee replacement.  Some insurance carriers may not have issued a policy had the knee replacement been disclosed prior to taking out the policy.

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.

Paul Potter · Answer

This is a really good question. If you were in your Guaranteed Issue Election Period, the answer is yes. If you were not, it depends. A critical element in all applications is to make sure that you disclosed this on your application. As you would expect, leaving such an important item off your application could cause the insurance company to drop coverage.

Answered by Paul Potter on July 1, 2025

Broker Licensed in FL

Answered by Paul Potter Medicare Insurance Agent

Darlene Murphy · Answer

Medicare does not look at pre-existing when you sign-on originally. You will be covered primary by Medicare for approved expenses, and the secondary must cover the balance as outlined by your supplement.

Answered by Darlene Murphy on January 5, 2026

Broker Licensed in CA, AZ, ID & 7 other states

Answered by Darlene Murphy Medicare Insurance Agent

Michelle Sparks · Answer

That is a great question. If you qualified for a guarantee issue when you signed up for your Plan G Medicare Supplement, it will likely be covered if medically necessary. 

You get a guaranteed issue Medicare Supplement (Medigap) plan during your 6-month Medigap Open Enrollment Period (starting when you turn 65 and enroll in Part B) or when specific events trigger "guaranteed issue rights". These rights allow you to buy a policy without medical underwriting (no denials for pre-existing conditions). 

Examples of other triggers that may qualify you for guaranteed issue are below: 

1) Losing Employer Coverage
2) Medicare Advantage (MA) plan leaves your area or is no longer available to you
3) Trial Rights to Medigap/Medicare Supplement (you joined a Medicare Advantage Plan and within the first year want to change to a Medicare Supplement)
4) Coverage ends due to circumstances beyond your control (e.g. bankruptcy etc.)

Finally, keep in mind that there are important timeframes that you need to adhere to. In most cases, you must apply for a policy 60 days before your coverage ends and no more than 63 days after it ends. If you are in your initial 6-month open enrollment, you can choose any plan, but with "guaranteed issue rights" based on loss of coverage, you are typically limited to buying plans A, B, C, D, F, G, K, or L.

I recommend reaching out to a local Medicare Broker to help you navigate these complex decisions at least 3 months in advance of needing a Medicare Medigap/Medicare Supplement Plan. In most cases, that will be when you are turning 65, retiring and leaving an employer group health plan or losing your current coverage.

Stella Hattox · Answer

It depends on if your Plan G was a Guarantee Issue policy or Underwritten.  Your agent should be able to answer that question for you.

Kirk Hale · Answer

That all depends on your situation. If you were new to Medicare, meaning you got part B for the 1st time then yes pre-existing conditions won't matter. If you were underwritten and had to answer health questions and knowingly answered NO to the questions about knee or joint replacement, then yes, the insurance company could deny the claim because of misrepresentation and can even resend your policy. If an agent told you to do this the agent could lose his/her license. So, I always tell my clients you need to just be honest and answer the questions truthfully and if an agent is telling you not to be truthful you need to run away from them fast.

Likely the insurance company will probably know about your knee replacement anyway if you have seen a doctor about it when you apply if you are not in open enrollment or guarantee issue. I had a client tell me once that the underwriter knew more about her health conditions than she did.

Steven Bleicher · Answer

Without a doubt. When you first joined Medicare at age 65, you were considered to be what is known as a "Guarantee Issue" person, answering no medical questions at all; not even disclosing any pre-existing conditions!  It was with the understanding that eventually, there would be health issues that would crop up. Now that you need a total knee replacement, this is the first of possibly many aspects of your health that your Supplement was destined to pay for. Just remember: If health issues were of concern to any Medicare Supplement insurance company, the application submitted would have included your list of those health afflictions along with the names, dosages and frequency of the drugs your doctor has prescribed for you. Since that didn't happen, joining Medicare & having this surgery does NOT mean that it won't be covered!!
You sound like you think you did something wrong. You did not; don't feel guilty!!

Cleo Martin · Answer

Yes it will, but I'm surprised there wasn't a question on there about planned surgeries in an underwritten one. If guaranteed issue, or initial enrollment, there wouldn't have been any questions. There should be no problem with them covering it.

Answered by Cleo Martin on December 15, 2025

Agent Licensed in SC, FL, GA, MI & NC

Answered by Cleo Martin Medicare Insurance Agent

Victoria Shiu · Answer

That’s a really important question — and the answer depends on timing and underwriting rules for your Medigap Plan G.

If you bought Plan G during your 6-month open enrollment at age 65 (or when you first got Part B): Your Medigap must pay its share, even if the surgery was already scheduled.

If you bought outside that window: Whether Plan G pays depends on your prior coverage history and whether the insurer applied a pre-existing condition waiting period.

Ron Hamilton · Answer

What was your effective date for your Plan G?  When is your surgery scheduled and who is the carrier for the plan?

Rosalind Ryan · Answer

Yes, Plan G can cover a total knee replacement—even if scheduled before purchase—provided you enrolled during your Medigap Open Enrollment Period. It fills gaps in Medicare coverage by paying deductibles, copayments, and coinsurance. If enrolled outside that window, a waiting period for pre-existing conditions may apply.

Answered by Rosalind Ryan on June 4, 2025

Broker Licensed in GA, AL, FL & 8 other states

Answered by Rosalind Ryan Medicare Insurance Agent

Kim Humphries · Answer

Yes,  Medicare will pay 80% of your costs and your plan G picks up the other 20%.  It doesn't matter how long you have had it.   Kim H.

Jodi Gatlin · Answer

Well, that depends. If you enrolled in the supplement plan during your initial enrollment period or a guarenteed enrollment , your supplement pays for anything Medicare approves. Pre-existing conditions are covered in this circumstance. A supplement pays after Original Medicare pays, therefore, if Medicare approves and pays, then so does the supplement plan.

Answered by Jodi Gatlin on April 8, 2026

Broker Licensed in WA

Answered by Jodi Gatlin 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.

Andrew Kramer · Answer

If you took out your G supplement in your guaranteed issue period, i.e. 6 months within the start of your Part B, then yes, you are fully covered. But if you took out the policy outside of your guaranteed issue period and did not inform them of the pending knee replacement, and they did not find it in your medical records, then no, you would not be covered.

Answered by Andrew Kramer on June 24, 2025

Agent Licensed in FL

Answered by Andrew Kramer Medicare Insurance Agent

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.

Dean Chiapetto · Answer

As long as the Surgeon accepts Medicare, you supplement will pay what they are supposed to. Once the insurance company offers you a policy and you accept, the contract is in force, as long as there was no fraud.

Answered by Dean Chiapetto on November 1, 2025

Broker Licensed in VA, MD, NC, TN & WV

Answered by Dean Chiapetto Medicare Insurance Agent

Deborah Webster · Answer

When you either have a guaranteed issue (first turning 65 or enrolling in Part B) or pass the underwriting questions for a supplement, pre-existing conditions do not factor into your coverage. You will have no issue with the supplement company covering the cost of your surgery once you have met your deductible.

Answered by Deborah Webster on October 22, 2025

Broker Licensed in Ia & SC

Answered by Deborah Webster Medicare Insurance Agent

Toni Cormier · Answer

Medicare Supplemental plans typically cover pre-existing conditions; however, there is typically a 6mos waiting period if you are not in your initial enrollment period.

Tamela Clayton · Answer

Assuming your Medicare Supplement Plan G was issued during your initial Medigap enrollment period, medical underwriting would not apply.

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

Lillian Hill · Answer

Several factors to be considered.

What phase of Medicare are you in?

 For example:

If your plan enrollment in Part B is to take place during the guaranteed period of turning 65, then you will not be disqualified as having a pre-existing condition. During this enrollment period, no health questions (underwriting) are to be asked. 

If you can prove having credible health care that did not include a break in coverage longer than 63 days, the pre-existing waiting period may be waived.

If outside of the guaranteed issue window, you are approved by underwriting, and a Medigap policy is issued, then pre-existing conditions may impact your plan G coverage by stipulating a waiting period before benefits will pay.

Jami Mead · Answer

Yes your Plan G will still cover the surgery if it was already scheduled and approved by Medicare. You can call the customer service line of your new policy to confirm as well, however, as long as your surgeon has the plan information they should take care of that for you.

Answered by Jami Mead on July 28, 2025

Broker Licensed in OH, FL, GA & 11 other states

Answered by Jami Mead Medicare Insurance Agent

James Wareheim · Answer

It depends.  Were you in your initial open enrollment.  In other words did you just turn 65?  If so yes.

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

Broker Licensed in TX, AL, AR & 29 other states

Answered by Tony Merwin Medicare Insurance Agent

Tonya White · Answer

It depends on how long ago you took out your policy, if you aged in for eligibility i.e. just turned 65, or other factors. If you just took out your policy and you didn't have a guarantee issue basis, such as turning age 65, there is a medical underwriting question you would have had to answer which is about upcoming surgeries. If you were not honest with this answer, they can terminate your policy. You question does not provide enough information to answer so I suggest you call your agent/broker, or the plan to get an answer based on your scenario and all that is involved.

Answered by Tonya White on October 26, 2025

Agent Licensed in CA, MA, MI & 5 other states

Answered by Tonya White Medicare Insurance Agent

Angelina Watkins · Answer

If the date of service is after the effective date of your Medicare Supplemental Plan G, your policy will pay the portion not covered by Original Medicare. However, you should check with your provider to verify your specific coverage.

Answered by Angelina Watkins on November 24, 2025

Agent Licensed in OH, FL, GA & 5 other states

Answered by Angelina Watkins Medicare Insurance Agent

Humara Riaz · Answer

Thank you for reaching me out , my is Humara Riaz licensed insurance agent.
Yes, your plan G will pay you. If you are paying a premium every month.

Dominic Colonero · Answer

Yes it will. You will have to pay for the deductible (if you have not already) ,  but afterwards your supplement will pay the rest. Make sure the supplement plan is effective before the surgery.

Kim White · Answer

Yes, unless you needed to go through underwriting and didn’t answer the questions correctly. If you enrolled during a guaranteed issue, your plan G will pay.

Susan Winters · Answer

Because specific rules can vary slightly by company and state:

Confirm the policy’s effective date

Ask whether there’s a pre-existing condition waiting period on your Plan G

Check if your knee condition or surgery falls under that waiting period

If there is a waiting period, Medicare will still pay its share — but Plan G may not pay its portion for that condition until the waiting period ends.

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.

Dan Griggs · Answer

Yes. Plan G has no prequalifying questions to ask either pre or post policy date and any provider that accepts Medicare will accept any Carrier Plan G

Kevin Price · Answer

Absolutely, plan G will cover the cost at 100%. You will never pay any out of pocket cost for the procedure.

Dismery Gonzalez · Answer

Yes. If Medicare approves the surgery, your Medicare Supplement Plan G will still pay its share after Medicare pays, even if the knee replacement was already scheduled when you enrolled. The only out-of-pocket cost Plan G doesn’t cover is the Part B deductible.

Answered by Dismery Gonzalez on March 5, 2026

Broker Licensed in NY

Answered by Dismery Gonzalez Medicare Insurance Agent

Teresa Scott-Carano · Answer

In general if your surgery is scheduled AFTER your policy effective date and the surgery is medically necessary- the Medigap plan (Plan G) will be billed AFTER Medicare processes the claim. If it were me; I would call the customer service line for my Medigap policy and confirm your coverage and how it will handle your upcoming surgery. Good luck and take care. Teresa Scott Carano PA/OH Agent

Answered by Teresa Scott-Carano on June 11, 2025

Agent Licensed in PA & OH

Answered by Teresa Scott-Carano Medicare Insurance Agent

Wanda Martinez-Tirado · Answer

Yes, if you enrolled during your Medigap open enrollment period or a Guaranteed issue window, Medicare Supplement Plan G will pay secondary to Medicare, it covers coinsurance, copays and other gaps after Medicare pays, but does not cover the part B deductible. Then your plan must cover pre-existing conditions, including a schedule surgery. No medical underwriting applies. But if you enrolled in Plan G outside a protected timeframe the insurer may have require medical underwriting and some carriers impose a waiting period up to 6 months for pre-existing conditions, if the surgery was disclosed during underwriting, coverage may be delay-but not denied

Answered by Wanda Martinez-Tirado on September 16, 2025

Broker Licensed in TX

Answered by Wanda Martinez-Tirado 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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