Final answer:
Only one claim is sent to Medicare when a patient is covered by both Medicare and a Medigap plan. After Medicare has paid its share, the details are automatically sent to the Medigap plan without the need to submit a separate claim.
Step-by-step explanation:
When a patient is covered by both Medicare and a Medigap plan, only one claim is sent directly to Medicare. This is because Medicare is always the initial payer who covers eligible hospital and medical costs under Part A and Part B. Once Medicare pays its share, the claim, along with the summary of benefits that Medicare did not pay for, is automatically sent to the Medigap plan that the individual has purchased.
The Medigap policy is a supplemental insurance that is designed to pay for costs not covered by Medicare, such as copayments, deductibles, and other out-of-pocket expenses. Therefore, in this situation, two claims are processed altogether, but it is important to note that the patient or the healthcare provider does not have to send two separate claims; the second claim to Medigap occurs after Medicare's initial claim processing.