Unlike other Medigap plans, Medigap Plans C and F are not available for those newly eligible for Medicare after January 1, 2020. These plans are being phased out. Medigap plans, also called Medicare supplement plans, are optional standardized plans provided by private insurers. There are currently 10 options, represented by letters: Plans A, B, C, D, F, G, K, L, M, and N. Medigap plans help cover some of the out-of-pocket costs associated with Original Medicare.
Medicare recipients pay an annual deductible for Part B-covered services before Medicare coverage kicks in. Plans C and F are unique in that they cover this yearly deductible. These plans provide some of the most comprehensive coverage for out-of-pocket expenses, but are only available under certain conditions.
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Medigap Plans C and F Eligibility
Those interested in Medigap Plan C or F must have first been eligible for Medicare on or before January 1, 2020. If you first became eligible for Medicare after January 1, 2020, you cannot enroll in Medigap Plans C or F.
However, even if you cannot get Medigap Plans C or F, you have other options for Medigap coverage. Each standardized Medigap plan offers the same coverage as other plans with the same identifying letter. For example, Medigap Plan A offered by one insurer will cover the same benefits as another Medigap Plan A offered by a different insurer. However, Massachusetts, Minnesota, and Wisconsin residents have different Medigap options unique to each state.
You can also choose a Medicare Advantage (MA) plan instead of Medigap. MA plans, also called Medicare Part C, provide an alternative way to get Medicare Part A and B coverage, and most MA plans include Medicare Part D and other benefits as well. However, MA plans have other restrictions, such as healthcare network limitations.
How Medigap Works
All Medigap plans cover the “gaps” in your Original Medicare coverage by paying some of the program’s out-of-pocket costs, such as copays and coinsurance. As such, Medigap plans only work with Original Medicare coverage and are not compatible with MA plans.
Although Medigap plans come with a premium, the cost of keeping the policy active each month may be significantly less than what you would otherwise pay in coinsurance and deductibles. In fact, 12% of Original Medicare enrollees without Medigap in 2019 reported issues with paying their medical bills, compared to just 4% of enrollees who had Medigap. Depending on your frequency and type of health care needed, Medigap may help you save in the long run.
What Medicare Supplement Plan C Covers
Medigap Plan C provides coverage for more out-of-pocket Medicare costs than any other plan except Plan F. Plan C enrollees receive 100% coverage for:
- Skilled nursing facility coinsurance
- Part A hospice care coinsurance
- The first three pints of blood when a transfusion is necessary
- Medicare Part B coinsurance
- Medicare Part A coinsurance
- Part A and Part B deductibles
Plan C also provides coverage for 80% of medical costs for foreign travel emergencies.
Plans D, G, and N provide coverage similar to Plan C. However, these plans do not cover Part B deductibles. With Plan N, you may also pay copayments for some doctor’s office and emergency room visits.
In addition, Medicare Plan C and Medicare Part C sound similar, but they are not the same. Part C refers to Medicare Advantage plans, while Plan C is strictly associated with Medigap plans.
What Plan C Does Not Cover
Plan C does not cover Part B excess charges, which you may incur if your healthcare provider does not accept the Medicare-approved amount as full payment and bills you for excess charges. Medigap plans also generally do not cover prescription drugs, long-term care, vision care, dental care, or private-duty nursing.
What Medicare Supplement Plan F Covers
Plan F provides the same coverage as Plan C, including coverage for Part B deductibles, no matter how much those costs increase over time. Unlike Plan C, Plan F covers Part B excess charges.
While there is not an exact match replacement for Plan F, Plans G and N provide the same general coverage as Plan F, though without the Part B deductible. Plan N also requires small copayments for doctor’s office and emergency room visits, but may have a lower premium than Plan G.
What Plan F Does Not Cover
Like Plan C, Plan F does not provide coverage for healthcare costs not covered by Medigap plans, including vision and dental care, long-term care, prescription drugs, and private-duty nursing.
Medigap Plans C and F vs. Other Medigap Options
Benefits | Plan C | Plan F | Plan A | Plan B | Plan D | Plan G | Plan K | Plan L | Plan M | Plan N |
|---|---|---|---|---|---|---|---|---|---|---|
Part A coinsurance and hospital costs for up to 365 additional days after Medicare benefits are disbursed | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
Part B coinsurance or copayment | Yes | Yes | Yes | Yes | Yes | Yes | 50% | 75% | Yes | 100% coinsurance; but copays may still apply |
Part A hospice care coinsurance or copayment | Yes | Yes | Yes | Yes | Yes | Yes | 50% | 75% | Yes | Yes |
Part A deductible | Yes | Yes | Not covered | Yes | Yes | Yes | 50% | 75% | 50% | Yes |
Part B deductible | Yes | Yes | Not covered | Not covered | Not covered | Not covered | Not covered | Not covered | Not covered | Not covered |
Part B excess charge | Not covered | Yes | Not covered | Not covered | Not covered | 100% | Not covered | Not covered | Not covered | Not covered |
Out-of-pocket limit | N/A | N/A | N/A | N/A | N/A | N/A | $6,940 in 2023 | $3,470 in 2023 | N/A | N/A |
Blood (first three pints) | Yes | Yes | Yes | Yes | Yes | Yes | 50% | 75% | Yes | Yes |
Skilled nursing facility care coinsurance | Yes | Yes | Not covered | Not covered | Yes | Yes | 50% | 75% | Yes | Yes |
Foreign travel exchange up to plan limits | 80% | 80% | Not covered | Not covered | 80% | 80% | Not covered | Not covered | 80% | 80% |
Plans C and F differ from other Medigap plans because they provide coverage for 100% of the annual Part B deductible. Those who meet the eligibility criteria for Plans C or F may enroll in either for the most coverages offered by any Medigap plan.
However, if you are not eligible for Plans C or F, consider Plans N or G, which offer much of the same coverage.
Medigap Plans C and F vs. Medicare Advantage
If you do not meet the criteria for Plans C or F or want access to the benefits provided by MA plans, you have options. Your budget for healthcare costs, your travel plans and lifestyle, the available network of healthcare providers, and your health forecast are important factors that can help you decide whether an MA plan or Medigap would best meet your needs.
As a supplement to Original Medicare, Medigap plans provide coverage for Medicare-approved healthcare service provided by any doctor or hospital in the United States accepting Medicare. This means Medigap plans are applicable anywhere in the United States, which may be attractive to people who spend part of the year away from home or travels between states frequently.
On the other hand, Medicare Advantage plans often offer more benefits than Original Medicare, such as Part D drug coverage, dental, and vision health. Some MA plans also feature a zero-dollar premium, making it less costly upfront than Medigap plans. However, MA plans tend to set their own copays, coinsurance, and deductibles, and depending on how often you need to access health services, it may cost more in the long run than paying for Original Medicare and Medigap.
How to Enroll in Medigap Plans C or F — If You’re Eligible
If you are eligible for Medigap Plans C or F and wish to enroll, pay attention to your initial enrollment period. Outside of this period, you can apply to enroll at any time, but insurers have the right to deny your application or charge more based on your health status.
Medigap Initial Enrollment Period
- When: 6-month period that begins after you first enroll in Medicare Part B
- What You Can Do: Enroll in a Medigap plan with the same options and premium as a healthy individual
If you were eligible for Medicare prior to January 1, 2020 but have delayed enrollment in Part B until now, your Medigap initial enrollment window will begin the month you enroll in Part B. This is the ideal time to enroll in any Medigap plan because all plans must be made available to you and your premium will be the same as one offered to someone in good health. Outside this period, you may have to go through medical underwriting to gain access to Medigap plans.