Medigap
Standardized Medicare supplemental insurance policies (Plans A through N) that pay some of the costs Original Medicare does not.
1 min read · Last reviewed May 23, 2026
At a glance
- Category
- Payer
- Primary sources
- 1
- Workspace handoff
- ask d3 →
Where this comes up
Front-office and billing both hit this term — eligibility before the visit, prior auth before the procedure, contract terms during fee-schedule negotiation, and credentialing whenever a new provider joins or a payer roster lapses. Misses here become denials downstream.
Full definition
What it is in practice
Medigap policies are standardized across most states (Massachusetts, Minnesota, Wisconsin use distinct frameworks). They pay Part A/B deductibles, coinsurance, and excess charges depending on plan letter.
How it shows up in your practice
Most Medigap claims cross over automatically when Medicare adjudicates. Verify the crossover in the EOB so the patient is not balance-billed unnecessarily.
Sources
- CMS — Physician Fee Schedulehttps://www.cms.gov/medicare/payment/fee-schedules/physician
Look up Medigap crossover rules in Ask D3
Open ask d3 →Related terms
- PayerMedicare Part AThe hospital insurance part of Medicare, covering inpatient hospital, skilled nursing facility, hospice, and limited home health.
- PayerMedicare Part BThe medical insurance part of Medicare, covering physician services, outpatient care, durable medical equipment, and preventive services.
- PayerCoordination of Benefits (COB)The rules and processes that determine which of two or more insurance plans pays first when a patient is covered by multiple plans.
D3rx is a healthcare-billing and compliance research aid maintained by D3rx Inc. Articles are drafted by an LLM (Anthropic Claude) against primary HHS, OCR, CMS, eCFR, NIST, and state-regulator publications, and reviewed for restraint and source fidelity by the D3rx team.
Reviewer status: a named credentialed reviewer (CHC, CHPC, or healthcare attorney) is being engaged. Until that engagement is finalized, this page does not claim credentialed review.
Related across the archive
- GlossaryMedicare Part BThe medical insurance part of Medicare, covering physician services, outpatient care, durable medical equipment, and preventive services.
- GlossaryCoordination of Benefits (COB)The rules and processes that determine which of two or more insurance plans pays first when a patient is covered by multiple plans.
- GlossaryMedicare Part AThe hospital insurance part of Medicare, covering inpatient hospital, skilled nursing facility, hospice, and limited home health.
- GlossaryCardiac Stress Test (93015-93018)CPT codes for cardiac stress testing, with separate codes for the global service, supervision, and interpretation.
- GlossaryCharge CaptureThe process of identifying and recording every billable service furnished during a patient encounter.
- GlossaryClean Claim RatePercentage of claims accepted by the payer on first submission without edits or rejections.
- GlossaryConversion FactorThe dollar value multiplied by the geographically-adjusted Relative Value Unit to determine the Medicare-allowable amount for a service.
- ComplianceOIG LEIE Monthly Exclusion Screening: Process + Audit-Ready LogsMonthly OIG LEIE and SAM.gov exclusion screening for every workforce member and vendor: the workflow, the log fields auditors require, and the escalation path.
This glossary entry is a research aid for billing and compliance staff. It does not provide legal, medical, or financial advice and does not replace counsel. References cited link to primary sources at HHS, OCR, CMS, eCFR, NIST, and the relevant payer or industry body.