Medigap Surgery Costs 2026: What You Pay Out-of-Pocket for Common Surgeries by Plan

TL;DR Quick Answer

With Medigap Plan G, you pay nothing for Medicare-approved surgeries after the $257 annual Part B deductible. Plan F covers everything with zero out-of-pocket. Plan N adds $20 doctor copays and $50 ER visits. High-Deductible Plan G requires you to meet the $2,800 deductible before coverage kicks in. For a typical knee replacement costing $30,000, Plan G saves you roughly $1,676 (Part A deductible) + most Part B coinsurance compared to having Original Medicare alone.

Key Takeaways

1. Plan G covers 100% of Medicare-approved surgery costs after the $257/year Part B deductible — including surgeon fees, facility fees, and anesthesia
2. Plan F is the only plan with truly $0 out-of-pocket for Medicare-covered surgeries, but it’s not available to people who became Medicare-eligible after January 1, 2020
3. Plan N charges copays for doctor visits ($20) and ER visits ($50), which can add up during pre-surgery consultations and post-op follow-ups
4. High-Deductible Plan G requires meeting a $2,800 deductible in 2026 before Medigap pays anything — a major factor for planned surgeries
5. Skilled Nursing Facility (SNF) rehab after surgery is covered differently — Plan G covers the $209.50/day coinsurance for days 21-100; Plan N and HD-G may not
6. Hidden surgery costs like anesthesia, pathology, and imaging are covered under Part B — meaning Plan G handles them at 100% after the deductible

How Medicare Splits Surgery Costs: Part A vs Part B

Understanding how Medicare divides your surgery bill is essential for knowing what your Medigap plan will pay.

Medicare Part A (Hospital Insurance) Covers:

• Inpatient hospital stay (operating room, nursing care, room and board)
• Inpatient surgery facility fees
• Semi-private room during recovery
• Meals and general nursing during your hospital stay

2026 Part A Costs (Original Medicare alone):

• Deductible: $1,676 per benefit period (can be charged multiple times per year)
• Coinsurance days 1-60: $0 (after deductible)
• Coinsurance days 61-90: $419 per day
• Coinsurance days 91+ (lifetime reserve): $838 per day
• Skilled Nursing Facility days 1-20: $0
• Skilled Nursing Facility days 21-100: $209.50 per day

Medicare Part B (Medical Insurance) Covers:

• Surgeon’s professional fees
• Anesthesiologist fees
• Outpatient surgery facility fees (ambulatory surgery centers)
• Pre-operative testing and imaging
• Post-operative follow-up visits
• Durable medical equipment (crutches, walkers, braces)

2026 Part B Costs (Original Medicare alone):

• Annual deductible: $257
• Coinsurance: 20% of all Medicare-approved amounts after deductible

The critical takeaway: Original Medicare alone leaves you exposed to the $1,676 Part A deductible, unlimited 20% Part B coinsurance, and SNF costs. That’s where Medigap steps in.

2026 Surgery Cost Breakdown by Medigap Plan

Below is a detailed breakdown of what you’d pay for six common surgeries under each popular Medigap plan. All amounts assume Medicare-approved rates for 2026.

1. Knee Replacement (Total Knee Arthroplasty)

Total estimated cost: $22,000 - $35,000 (inpatient, 2-3 day hospital stay)

Cost Component	Amount	Medicare Pays	Plan G Pays	Plan N Pays	Plan F Pays	HD-G Pays
Part A deductible	$1,676	—	$1,676 ✅	$1,676 ✅	$1,676 ✅	$0 (until $2,800 met)
Part A coinsurance (days 1-60)	$0	$0	—	—	—	—
Surgeon fee (20% Part B)	~$4,200	80% ($3,360)	$840 ✅	$840 ✅*	$840 ✅	$0 (until deductible met)
Anesthesia (20% Part B)	~$1,000	80% ($800)	$200 ✅	$200 ✅*	$200 ✅	$0 (until deductible met)
Your Total Out-of-Pocket	—	~$1,676	~$0 (after Part B deductible)	~$257 + copays	$0	Up to $2,800

*Plan N: 20% coinsurance is covered, but surgeon visit copays of $20/visit apply for pre-op and post-op consultations.

With Plan G: Your only cost is the $257 annual Part B deductible (if not already met). Plan G pays the entire $1,676 Part A deductible and all 20% Part B coinsurance.

With Plan N: You pay the $257 Part B deductible + $20 copay per doctor visit (typically 4-6 visits for pre-op consults, hospitalist visits, and post-op follow-ups = $80-$120 in copays).

With High-Deductible Plan G: You pay the first $2,800 out-of-pocket. Since the knee replacement’s Medicare coinsurance (Part A deductible + Part B 20%) is roughly $2,716-$3,000, you’ll likely pay close to the full $2,800 deductible.

2. Hip Replacement (Total Hip Arthroplasty)

Total estimated cost: $20,000 - $32,000 (inpatient, 1-3 day hospital stay)

Cost Component	Amount	Medicare Pays	Plan G Pays	Plan N Pays	Plan F Pays	HD-G Pays
Part A deductible	$1,676	—	$1,676 ✅	$1,676 ✅	$1,676 ✅	Subject to $2,800 deductible
Surgeon fee (20% Part B)	~$3,800	80% ($3,040)	$760 ✅	$760 ✅	$760 ✅	Subject to $2,800 deductible
Implant hardware (Part A)	Included	✅	—	—	—	—
Physical therapy rehab (Part B)	~$1,500	80% ($1,200)	$300 ✅	$300 ✅*	$300 ✅	Subject to $2,800 deductible
Your Total Out-of-Pocket	—	~$2,276	~$257 (Part B deductible only)	~$337 + $20 copays	$0	Up to $2,800

*Plan N: PT sessions may require $20 copay each if classified as doctor visits (typically 6-12 sessions = $120-$240 additional).

3. Heart Bypass Surgery (CABG)

Total estimated cost: $70,000 - $200,000 (inpatient, 5-7 day hospital stay)

Cost Component	Amount	Medicare Pays	Plan G Pays	Plan N Pays	Plan F Pays	HD-G Pays
Part A deductible	$1,676	—	$1,676 ✅	$1,676 ✅	$1,676 ✅	Subject to $2,800 deductible
Part A coinsurance (days 61-90)	$419/day × 3 = $1,257	$0	$1,257 ✅	$1,257 ✅	$1,257 ✅	Subject to $2,800 deductible
Surgeon + surgical team (20% Part B)	~$12,000	80% ($9,600)	$2,400 ✅	$2,400 ✅	$2,400 ✅	Subject to $2,800 deductible
Anesthesia (20% Part B)	~$3,000	80% ($2,400)	$600 ✅	$600 ✅	$600 ✅	Subject to $2,800 deductible
Cardiac rehab (Part B, 36 sessions)	~$3,000	80% ($2,400)	$600 ✅	$600 ✅*	$600 ✅	Subject to $2,800 deductible
Your Total Out-of-Pocket	—	~$5,933	~$257	~$337 + copays	$0	$2,800 (deductible met, everything else covered)

Heart bypass is where Medigap’s value becomes crystal clear. Without Medigap, a 7-day CABG hospitalization could cost you nearly $6,000 in coinsurance. Plan G reduces that to $257 — the Part B annual deductible.

*Plan N: Cardiac rehab copays of $20/session for 36 sessions = $720 additional.

4. Cataract Surgery

Total estimated cost: $3,500 - $5,000 per eye (outpatient, same-day procedure)

Cost Component	Amount	Medicare Pays	Plan G Pays	Plan N Pays	Plan F Pays	HD-G Pays
Ambulatory Surgery Center fee (20% Part B)	~$2,000	80% ($1,600)	$400 ✅	$400 ✅	$400 ✅	Subject to $2,800 deductible
Surgeon fee (20% Part B)	~$800	80% ($640)	$160 ✅	$160 ✅	$160 ✅	Subject to $2,800 deductible
Anesthesia (20% Part B)	~$400	80% ($320)	$80 ✅	$80 ✅	$80 ✅	Subject to $2,800 deductible
Intraocular lens (Part B)	Included in facility fee	✅	—	—	—	—
Your Total Out-of-Pocket (per eye)	—	~$640-$900	~$0 (if Part B deductible met)	~$0 + $20 copay	$0	~$640-$900 (unlikely to meet $2,800 deductible for one eye)

Cataract surgery is performed in an outpatient setting, so it falls entirely under Part B. If you’ve already met your $257 Part B deductible earlier in the year, Plan G and Plan F cover cataract surgery at 100% with zero out-of-pocket.

For HD-G enrollees, a single cataract surgery ($640-$900 in coinsurance) likely won’t exceed the $2,800 deductible, meaning you’d pay the full coinsurance amount unless you’ve had other medical expenses earlier in the year.

5. Hernia Repair

Total estimated cost: $6,000 - $12,000 (typically outpatient)

Cost Component	Amount	Medicare Pays	Plan G Pays	Plan N Pays	Plan F Pays	HD-G Pays
Facility fee (20% Part B)	~$2,400	80% ($1,920)	$480 ✅	$480 ✅	$480 ✅	Subject to $2,800 deductible
Surgeon fee (20% Part B)	~$1,200	80% ($960)	$240 ✅	$240 ✅	$240 ✅	Subject to $2,800 deductible
Anesthesia (20% Part B)	~$600	80% ($480)	$120 ✅	$120 ✅	$120 ✅	Subject to $2,800 deductible
Surgical mesh (if used)	Included	✅	—	—	—	—
Your Total Out-of-Pocket	—	~$840-$1,680	~$0 (if Part B deductible met)	~$0 + copays	$0	~$840-$1,680

6. Spinal Fusion

Total estimated cost: $80,000 - $150,000 (inpatient, 3-5 day hospital stay)

Cost Component	Amount	Medicare Pays	Plan G Pays	Plan N Pays	Plan F Pays	HD-G Pays
Part A deductible	$1,676	—	$1,676 ✅	$1,676 ✅	$1,676 ✅	Subject to $2,800 deductible
Part A coinsurance (days 1-60)	$0	$0	—	—	—	—
Surgeon + surgical team (20% Part B)	~$10,000	80% ($8,000)	$2,000 ✅	$2,000 ✅	$2,000 ✅	Subject to $2,800 deductible
Anesthesia (20% Part B)	~$2,500	80% ($2,000)	$500 ✅	$500 ✅	$500 ✅	Subject to $2,800 deductible
Imaging (MRI, CT, X-rays) (20% Part B)	~$1,000	80% ($800)	$200 ✅	$200 ✅	$200 ✅	Subject to $2,800 deductible
Bone growth stimulator (Part B DME)	~$2,000	80% ($1,600)	$400 ✅	$400 ✅	$400 ✅	Subject to $2,800 deductible
Your Total Out-of-Pocket	—	~$4,776	~$257	~$257 + copays	$0	$2,800 (deductible met)

Hidden Surgery Costs Most People Forget

Even with Medigap, certain costs can catch you off guard. Here’s what to watch for:

Anesthesia Services

Anesthesiologist bills are separate from your surgeon’s bill and fall under Part B. Plan G and Plan F cover the full 20% coinsurance. Plan N covers it too, but the anesthesiologist’s pre-op consultation may trigger a $20 copay.

Pathology and Lab Work

Tissue samples, blood tests, and biopsies sent during surgery are billed under Part B at 20% coinsurance. All Medigap plans cover this, but HD-G enrollees must check if their deductible has been met.

Post-Surgery Imaging

X-rays, MRIs, and CT scans during recovery are Part B services. A single post-op MRI can cost $500-$1,000, meaning the 20% coinsurance alone is $100-$200 — fully covered by Plan G after the deductible.

Durable Medical Equipment (DME)

Crutches, knee braces, walkers, and bone growth stimulators are classified as Part B DME. Medicare pays 80%, and Plan G covers the remaining 20%. For spinal fusion patients, a bone growth stimulator ($3,000-$5,000 retail) can generate $600-$1,000 in coinsurance that Medigap handles.

Recovery and Rehabilitation Costs

Inpatient Rehab Facility (IRF)

If you’re discharged to an Inpatient Rehabilitation Facility rather than a SNF, Medicare treats it as a hospital stay under Part A. The $1,676 deductible and daily coinsurance apply. Plan G covers all of it.

Skilled Nursing Facility (SNF)

After a 3-day inpatient hospital stay, Medicare covers up to 100 days in a SNF:

SNF Period	Daily Cost (2026)	Plan G	Plan N	Plan F	HD-G
Days 1-20	$0	—	—	—	—
Days 21-100	$209.50/day	✅ 100% covered	✅ 100% covered	✅ 100% covered	Subject to $2,800 deductible
Day 101+	100% your responsibility	❌ Not covered by any Medigap plan	❌	❌	❌

Important: SNF coverage requires a qualifying 3-night inpatient hospital stay. If you’re held under observation status (outpatient), Medicare Part B applies instead, and you won’t qualify for SNF benefits under Part A. See our guide on Medicare Observation Status and Medigap Surprise Bills.

Medigap Plan Comparison for Surgery Patients

Plan G: Best Overall for Surgery Protection

• Covers 100% of Part A deductible ($1,676) and coinsurance
• Covers 100% of Part B coinsurance (20% of surgeon, anesthesia, imaging)
• Covers Part B excess charges (if surgeon doesn’t accept assignment)
• Covers SNF coinsurance ($209.50/day, days 21-100)
• Your only cost: $257 annual Part B deductible

Plan N: Lower Premiums, Modest Surgery Copays

• Covers Part A deductible and coinsurance completely
• Covers most Part B coinsurance, but charges $20 copay per doctor visit
• Charges $50 ER visit copay (waived if admitted)
• Does NOT cover Part B excess charges
• Your surgery cost: $257 deductible + $80-$200 in visit copays for a major surgery

Plan F: Zero Out-of-Pocket (Not Available to New Enrollees)

• Covers everything Plan G covers PLUS the Part B deductible
• Truly zero out-of-pocket for all Medicare-covered services
• Only available if you were Medicare-eligible before January 1, 2020
• If you have Plan F, keep it — it’s the gold standard for surgery coverage

High-Deductible Plan G: Catastrophic Protection Only

• $2,800 deductible must be met before any Medigap benefits
• Monthly premiums are 30-50% lower than standard Plan G
• For a major surgery ($3,000+ in coinsurance), you’ll pay the full $2,800 deductible
• Best for: healthy individuals who want protection against catastrophic surgery costs but rarely use medical services

Plan K and Plan L: Partial Coverage Options

• Plan K covers 50% of Part B coinsurance — your surgery cost-sharing is halved but not eliminated
• Plan L covers 75% of Part B coinsurance — better protection but still leaves you with 25%
• Both have annual out-of-pocket limits ($7,220 for K, $3,830 for L in 2026)
• Not recommended if you anticipate surgery within the next 12 months

How to Estimate Your Surgery Costs Before Scheduling

Step 1: Check If Your Surgeon Accepts Medicare Assignment

Ask directly: “Do you accept Medicare assignment?” If yes, they can’t charge more than the Medicare-approved amount. If no, they may charge up to 15% more (excess charges), which only Plan G and Plan F cover.

Step 2: Request a Pre-Surgery Cost Estimate

Under the No Surprises Act and CMS price transparency rules, hospitals must provide good-faith estimates. Contact the hospital’s financial counseling department and request:

• Facility fee estimate (Part A)
• Surgeon fee estimate (Part B)
• Anesthesia fee estimate (Part B)
• Expected length of stay

Step 3: Verify SNF Coverage Eligibility

If post-surgery rehab is likely, confirm that your hospital stay will be classified as inpatient (not observation) for at least 3 nights. This determines SNF coverage eligibility.

Step 4: Use Our Medigap Cost Calculator

Our Medigap Plan Cost Estimator calculates your expected out-of-pocket costs based on your plan, state, and anticipated medical procedures.

Medicare Advantage vs Medigap for Planned Surgeries

If you’re choosing between Medicare Advantage (Part C) and Original Medicare + Medigap, surgery costs should factor heavily:

Factor	Medicare Advantage	Original Medicare + Medigap Plan G
Monthly premium	Often $0	$120-$200 (Plan G)
Annual deductible	Varies by plan	$257 (Part B only; Plan G covers rest)
Surgery out-of-pocket max	$3,000-$8,900 (plan-specific MOOP)	$257/year
Network restrictions	Must use in-network surgeons/facilities	Any Medicare-accepting provider
Pre-authorization	Often required for surgery	Never required
SNF coverage	Plan-specific, often limited	Standard Medicare rules (20/100 days)
Prior approval delays	Possible 1-14 day waits	None

Bottom line: If you anticipate a major surgery (joint replacement, cardiac procedure, spinal surgery), Medigap Plan G almost always results in lower total out-of-pocket costs than Medicare Advantage — even after accounting for the monthly premium.

Frequently Asked Questions

Does Medigap cover outpatient surgery center facility fees?

Yes. Ambulatory surgery center (ASC) facility fees are covered under Medicare Part B. Medigap Plan G covers the 20% Part B coinsurance after your annual $257 deductible. Plan F covers the deductible too, leaving you with $0 out-of-pocket. Plan N covers the 20% coinsurance but may charge a $20 copay for the surgeon’s visit associated with the procedure.

How much does knee replacement cost with Medigap Plan G in 2026?

With Medigap Plan G, a knee replacement typically costs you only the $257 annual Part B deductible (if not already met that year). Medicare-approved total costs range from $22,000-$35,000. Plan G covers the $1,676 Part A hospital deductible and all 20% Part B coinsurance (surgeon fees, anesthesia, imaging), leaving you with near-zero out-of-pocket for the surgery itself.

Will I pay anything for cataract surgery with Medigap Plan F?

No. With Medigap Plan F, you pay $0 for cataract surgery. Plan F is the only Medigap plan that covers the $257 Part B annual deductible in addition to all Part A and Part B coinsurance. Since cataract surgery is performed outpatient (Part B), Plan F covers 100% of the surgeon fee, facility fee, anesthesia, and intraocular lens. If you have Plan G instead, your only cost is the $257 deductible if not yet met.

Does Medigap cover robotic surgery (Da Vinci) costs?

Yes, as long as the robotic-assisted surgery is deemed medically necessary by Medicare. The Da Vinci surgical system costs are built into the facility fee (Part A for inpatient, Part B for outpatient). Medicare does not separately bill for robotic surgery technology. Medigap Plan G, Plan N, and Plan F all cover the standard Medicare coinsurance for the underlying procedure, regardless of whether robotic assistance is used.

How does Medigap handle surgery during a Medicare Advantage trial period?

During your 12-month Medicare Advantage Initial Enrollment Period (trial period), you can switch back to Original Medicare + Medigap at any time. However, if you need surgery mid-trial, you must first switch back to Original Medicare before your Medigap policy will pay. This transition can take 1-2 weeks. If emergency surgery is needed before the switch completes, your Medicare Advantage plan covers the surgery under its own cost-sharing rules. Plan your Medigap switch proactively if you anticipate upcoming surgery.

What happens if I need emergency surgery while traveling out of state with Medigap?

Medigap policies have no network restrictions — your coverage follows you nationwide. If you need emergency surgery in another state, any hospital and surgeon that accepts Medicare assignment will be fully covered under your Medigap plan’s terms. This is a significant advantage over Medicare Advantage HMO plans, which typically don’t cover out-of-network emergency surgery except in life-threatening situations. For international travel, Plans C, D, F, G, M, and N include foreign travel emergency coverage (80% after a $250 deductible, up to $50,000 lifetime).

Plan Your Surgery Costs with Our Calculator

Don’t guess what your surgery will cost. Use our free Medigap calculator to compare plans side-by-side based on your anticipated procedures, age, and state.

👉 Compare Medigap plans and estimate your surgery costs →

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Related Guides

• Medicare Supplement Skilled Nursing Facility Rehab Coverage 2026
• Medigap Plan G vs Plan N: Which Is Better in 2026?
• Best Medigap Plans by Health Profile 2026
• Medicare Supplement Plan Cost Estimator
• Medigap Coverage Gap Calculator
• Medicare Observation Status and Medigap Surprise Bills 2026
• How to File a Medigap Claim Step by Step

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