How Do Medicare and Medigap Pay My Medical Bills?

How Do Medicare and Medigap Pay My Medical Bills?

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 you medical bills. When it comes to paying your medical bills, this is 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.

Medicare Approval and Billing

Before a doctor will schedule surgery for you, or even an MRI, CAT scan or any similar expensive tests, his/her office will first get confirmation from Medicare that it will cover the bill. That communication is done electronically and very efficiently. Most of the time, you’re not even aware of the approval process taking place. After you’ve had your procedure, surgery, or tests, your doctors and hospital electronically bill Medicare. Then, Medicare will pay a portion of those pre-approved 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 a nice system.

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, though, that it’s up to you to check what treatments and services will be covered by Medicare and Medigap. 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 an easy process to file it yourself with Medicare. 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, so nothing gets too far behind or out of your control. You can also create an online Medicare account and view your bills there.

Bud Scannavino

About Bud Scannavino

Bud earned his MBA at Yale. He works with seniors, helping them with the financial issues of retirement, and especially Medicare. His practice is in the Atlanta, Georgia area. He's a regular contributor to