Brea Garahan Brea Garahan

Understanding and Explaining Patient Deductibles

Front-end administrative staff play one of the most important roles in the patient financial experience. You are often the first person a patient speaks to about their insurance, and your ability to explain key terms—especially deductibles—can prevent confusion, reduce billing complaints, and build patient trust from the very beginning.

But deductibles can be confusing even for seasoned staff, and explaining them in a clear, calm, and patient-friendly way requires practice. This guide breaks it down into simple language and helpful scripting you can use in real interactions.

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Brea Garahan Brea Garahan

How Medigap Plans Work

Medigap, also known as Medicare Supplement Insurance, plays a crucial role in the patient billing and reimbursement process. For healthcare administrative staff, understanding how these plans work ensures accurate communication with patients, cleaner claims, and fewer billing delays. Unlike Medicare Advantage plans, Medigap policies do not replace Medicare—they simply fill the financial gaps left after Medicare Part A or Part B pays. This can include deductibles, coinsurance, and other out-of-pocket costs depending on the plan type.

In practice, Medicare always pays first. Once Medicare processes a claim and determines its allowed amount, it automatically forwards the claim to the patient’s Medigap plan (known as the crossover process). The Medigap insurer then evaluates the remaining balance and pays their portion directly to the provider. When staff understand which parts Medicare covers and how Medigap steps in afterward, they can confidently explain patient responsibility, navigate coverage questions, and ensure accurate claim routing.

A clear grasp of Medigap fundamentals empowers front-end staff to provide better service, reduce confusion, and support a smoother revenue cycle for both patients and providers.

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