Where Does Medicare Fall Short?

[pirsquared]

Medicare sends the claim on to the Medigap insurer.

Here is an example of what you are asking, a $147 charge, first bill of the calendar year, so had all of the $233 deductible to go:
My Plan N EOB has columns for:
Amount Charged ($185); Medicare Approved Amount ($147.28); Applied to Medicare Deductible ($147.28); Medicare Paid ($0); Plan Cost Share [this is unique to Plan N]; Your Plan Paid ($0); and then an Item & Notes column.
So since the $233 deductible was not met yet, neither Medicare or the Medigap paid out anything, it's all mine to pay.
I see around a 2-3 week delay after Medicare makes a determination/pays, to the Medigap Plan taking action and showing up online. Sometimes it's faster than that.

We just got our first one, and while our supplemental plan is different (G), it's very similar.
Doc office charged a bunch, medicare allowed less for each one, Plan G paid zero , and the allowed medicare amounts totaled $202 , so it's all our bill as it's less than the deductible of $233.

Our supplemental plan had the EOB, which we looked at online, after seeing the doctor office bill (which nicely listed the medicare and supplemental numbers).
Both agreed with each other, which was nice to see it work smoothly.

Great! Thanks for the replies! The claim just showed up on Medicare.gov a few days ago, so I will expect to wait a couple of weeks before it shows up online for the Medigap plan. It is so helpful to know what to expect.

 

[JoeFromBoston]

Again, the key to this is "medically necessary". Medicare won't cover if not medically necessary. Medigap won't cover if not medically necessary. Medicare Advantage won't cover if not medically necessary. So, oops.

Medigap policies are ok when traveling abroad. However, buying a good travel insurance plan will provide a wider range of benefits not included in a Medigap plan, including 24/7 emergency medical assistance, repatriation, and coverage for trip interruption, delay, lost luggage, etc. And for major medical care, where your costs exceed $50,000, you are on your own.