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

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.

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.

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

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.

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!!

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, CA, FL & 7 other states

Answered by Steven Lovell Medicare Insurance Agent

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

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.

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

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

Broker Licensed in IL

Answered by Linda Davies Medicare Insurance Agent

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

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.

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.

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.

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

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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