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How Do Medicare and Medigap Pay My Medical Bills?

Last updated June 18th, 2020

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Medigap pays for some of the bills left over by Medicare’s coverage gaps – and it all happens automatically.

Medicare and Medigap work together smoothly to pay for your medical bills. It’s done automatically and usually without any input from you; that’s how Medigap policies work. That ease-of-use is a big appeal of owning a Medigap policy.

Your doctors are in charge of your medical care. They know that Medicare’s rules require that any procedure or treatment, such as surgery, a blood test or MRI, that the order is medically necessary. That means it is necessary to diagnose and treat a medical condition. After you’ve had your procedure, surgery, or tests, your doctors or the hospital electronically bill Medicare.  Medicare will pay its portion of the bills directly to your doctors and hospital.

Medigap Fills in the Gaps

After that, Medicare uses a system called “crossover” to electronically notify your Medigap insurance company that they have to pay the part of the remainder (the gaps) that your Medigap policy covers. All you have to remember is this: always show your Medigap policy identification card, along with your Medicare card, to your medical providers. The rest is done automatically for you. 

It’s Up to You to Be Vigilant in the Treatments and Services You Receive

If you’ve had problems with insurance companies not approving your medical treatments (like surgery), then you’ve probably noticed a very important point here. A Medigap insurer’s only role is to pay bills, bills that Medicare has already approved. This means, however, that it’s up to you to check what treatments and services will be covered. If a doctor suggests a certain treatment or surgery, make sure that it’ll be covered by Original Medicare or your Medigap policy.

If Billing Issues Arise

In rare cases, if a bill does get lost in the system or is left unpaid, it’s possible for you to file a claim with Medicare yourself. To help you monitor that, every three months Medicare will mail you an Explanation of Benefits (EOB) that summarizes all the bills they approved and paid on your behalf. You can also create an online Medicare account and view your bills there.

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