What Is Medigap Plan C?
Medigap Plan C, also called Medicare Supplement Plan C, is a type of additional coverage for Original Medicare. It provides benefits that help cover the “gap” between Original Medicare and out-of-pocket costs, such as Part A coinsurance and hospital costs or skilled nursing facility coinsurance. Plan C is only available if you were eligible for Medicare before Jan. 1, 2020. Keep in mind that those who were eligible for this coverage before that date but elected not to enroll can still access it, albeit with a more robust enrollment process.
Keep reading to learn more about how Medigap Insurance Plan C works, what it offers, and what differentiates it from other Medigap options.
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What Is Medigap?
Medigap is a type of supplementary healthcare insurance that helps pay out-of-pocket costs in Original Medicare. Medigap Plans are designated by letters: Plans A through D, F, G, and then K through N. Different plans offer different types and amounts of coverage and are offered through Medicare-approved private insurance companies. While prices may differ across providers, plans with the same letter offer the same benefits.
To enroll in Medigap, you must first enroll in Original Medicare Parts A and B. The first month after you enroll in Part B and are 65 or older, you start a six-month Medigap Open Enrollment period. During this period, you can choose any Medigap Plan available, and you cannot be denied due to preexisting health conditions. After this period, you can still buy a Medigap plan, but you may be denied coverage, or it may be more expensive.
How Does Plan C Work?
Once purchased, Plan C helps pay for services that Original Medicare does not fully cover. Here’s how it works.
To purchase any Medigap plan, you must be enrolled in both Part A and Part B of Original Medicare. If you have a Medicare Advantage plan, you are not eligible for Medicare Supplement Plan C or any other Medigap plan. If you have Original Medicare and make the move to a Medicare Advantage plan, you also lose your Medigap coverage.
In most cases, you are not eligible for Medigap plans until you have Part B Medicare and turn 65. Depending on your state, however, you may be eligible for Medigap early if you have a chronic medical condition or disability. Contact your state’s health insurance department or visit its website for more information.
Unlike other Medigap plans, Plan C is only available if you were eligible for Medicare before Jan. 1, 2020. This is also the case for Plan F. If you were eligible for Medicare after this date, you cannot enroll in Plan C.
What Medicare Supplement Plan C Covers
Medicare Supplement Plan C covers 100% of the following out-of-pocket costs from Part A and Part B Medicare:
- Part A coinsurance and hospital costs: This includes $400 coinsurance per day for days 61 to 90 in hospital and $800 per day for days 91 to 150. In addition, Plan C covers 365 days of inpatient hospital care and the 60 lifetime reserve days offered by Original Medicare.
- Part B coinsurance or copayments: Original Medicare covers 80% of Part B coinsurance and copayments. Plan C covers the remaining 20%.
- Blood (first three pints): The first three pints of blood drawn for transfusions or other medical applications are paid for under Plan C.
- Part A hospice care coinsurance or copayment: Plan C covers up to 5% of the Medicare-approved amount for respite care.
- Skilled nursing facility care coinsurance: From days 21 to 100, Plan C pays $200 per day.
- Part A deductible: As of 2023, the Part A deductible is $1,600, which is entirely covered by Plan C.
- Part B deductible: Plan C also covers the Part B deductible, which is $226 in 2023.
- Healthcare when traveling: Plan C covers 80% of the costs of care when you’re out of the country.
What Medicare Supplement Plan C Does Not Cover
Medigap Plan C does not cover Part B excess charges, which are fees charged by providers that are more than the Medicare-approved amount. In the case of excess Part B charges, patients pay out of pocket.
In addition, Plan C does not cover services such as:
- Long-term facility care
- Dental care
- Vision care and eyeglass costs
- Hearing aids
- Private duty nursing services
Plan C vs. Other Medigap Options
Plan C offers more coverage than most other Medigap options. For example, Plan C offers skilled nursing care coinsurance, while Plans A and B do not. Plan C also covers Part B deductibles — no other plans except for Plan F offer this coverage. In addition, Plan C provides 100% coverage for Part B coinsurance, Part A hospice coinsurance, and skilled nursing care coinsurance; Medigap Plan K and Plan L offer 50% and 75%, respectively.
If your eligibility for Original Medicare started on or after Jan. 1, 2020, however, you cannot enroll in Plan C.
What Costs Are Associated With Plan C?
Consider the example of an appendectomy, which is the surgery required if your appendix becomes infected. This surgery can cost up to $40,000, including hospital inpatient and outpatient services. Under Original Medicare, 80% of these costs are covered, leaving you with an $8,000 bill. With Plan C, the remaining 20% and your Part B and Part A deductibles are also covered. This means your only cost is your monthly premiums for Part A, Part B, and Plan C coverage.
Consider Plan C If…
Plan C provides more coverage than most Medigap Plans but may also have higher premium costs. Here are some key advantages and disadvantages of Plan C.
- Broad coverage
- Minimal out-of-pocket expenses
- Easy access to providers
- Short enrollment period
- Potentially higher premiums
- Limited eligibility
- Broad coverage: Plan C offers coverage for the 20% of costs not paid for by Medicare, along with Part A and B deductible coverage.
- Minimal out-of-pocket expenses: With Plan C, you only pay your Part A, Part B, and Plan C premiums out of pocket.
- Easy access to providers: Because Plan C falls under the umbrella of Original Medicare, you can use any provider that accepts Medicare patients.
- Short enrollment period: You have only six months after you have Part B and are over 65 to enroll in Plan C. After this period, you may be charged more for Plan C or denied coverage.
- Potentially higher premiums: Because Plan C covers everything except Part A premiums, it may have a higher premium than other Medigap plans.
- Limited eligibility: You can only enroll in Plan C if you were eligible for Original Medicare on or before Dec. 31, 2019.
How to Enroll in Plan C
Eligibility for any Medigap plan starts the month after you are 65 and have purchased Part B Medicare. You have six months from this date to enroll in a Medigap plan, and cannot be turned down for a preexisting condition.
After this period, you can enroll in a Medigap Plan at any time but may face higher premiums or may be denied by insurance providers. Unlike Original Medicare or Medicare Advantage, there are no yearly enrollment periods. Once your initial enrollment period is over, you can apply at any time but may be denied coverage.
Alternatives to Medicare Plan C
If you missed your initial enrollment period, you can still purchase Plan C if you meet the pre-2020 eligibility criteria.
If you do not meet this criteria or prefer a different Medigap option, consider Plans D or G. Plan G offers the same benefits as Plan C, except it does not offer Part B deductible coverage. Plan D, meanwhile, does not cover the Part B deductible or any Part B excess charges.
Putting It All Together
Medigap Plan C helps cover the 20% of costs that are not covered by Original Medicare and also covers Part A and Part B deductibles. This plan is only available to those who were eligible for Medicare coverage before Jan. 1, 2020. If your eligibility began after this date, consider Medigap options such as Plan D or Plan G, which offer similar coverage.