If a patient is covered by both Medicare and a Medigap plan, how many claims are sent to Medicare?

When a patient is covered by both Medicare and a Medigap plan, typically, only one claim is submitted to Medicare. This claim details the services provided, and Medicare processes it first. After Medicare adjudicates the claim, it will send the remaining amount, which may be covered by the Medigap plan, to the Medigap insurer for any secondary benefits that may apply.

As the primary payer, Medicare handles the claim directly and informs the Medigap issuer of the payment details. Therefore, regardless of the additional coverage provided by the Medigap plan, the process begins with a single claim submission to Medicare, justifying why one is the correct answer. This streamlined approach helps facilitate the coordination of benefits between Medicare and the supplementary Medigap coverage.