What Is Medigap Plan C?
Key Takeaways
- Like other Medigap plans, Medicare Supplement Plan C helps cover out-of-pocket costs not included in Original Medicare, such as copays, coinsurance, and deductibles.
- Medigap Plan C is only available to those who qualified for Medicare before 2020, which typically means individuals born in or before 1954, with some exceptions.
- Medigap Plan C offers comprehensive benefits, including coverage for the Part B deductible, skilled nursing coinsurance, and medically necessary emergency care for the first 60 days abroad.
Medigap Plan C is one of ten supplemental Medicare plans available, commonly called Medigap plans or Medicare supplement insurance. These plans help pay for out-of-pocket costs not covered by Original Medicare, which can help beneficiaries save on healthcare expenses. Medigap Plan C is unique because it is only available to those born in or before 1954. Learn more about Medigap Plan C eligibility criteria and coverages to see if it suits your needs.
Medigap At a Glance
Medigap, also known as Medicare supplement insurance, helps to pay for health costs not covered by Original Medicare. For example, after meeting the yearly Part B deductible, Medicare will pay 80% of the service’s covered amount. You are responsible for paying the remaining 20%. This is where Medigap can step in, helping to pay for that remaining 20%, as well as other out-of-pocket expenses such as coinsurance and deductibles.
Medigap plans can only be used with Original Medicare and are incompatible with Medicare Advantage plans. In most states, there are 10 Medigap plans, including Medigap Plan C.
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Understanding Medigap Plan C
Medigap Plan C is popular, accounting for 2.58% of all Medigap policies held in 2023. Though similar in name, Medigap Plan C is not to be confused with Medicare Part C, another name for Medicare Advantage plans. Medicare Part C is entirely different from Medigap Plan C.
Key Features of Medigap Plan C
- Not widely available. These plans are only available to those eligible for Medicare prior to January 1, 2020.
- Comprehensive. Medigap Plan C offers some of the most widest Medigap benefits available.
- International coverage. Medigap Plan C provides medical coverage for the first 60 days when traveling out of the country.
Eligibility Criteria for Medicare Supplement Plan C
Though Medigap Plan C used to be a popular supplemental plan option, enrollment has fallen as it is no longer available to all Medicare enrollees. Medigap Plan C is only available to those who became eligible for Medicare before January 1, 2020. Typically, this means you can only enroll in Medigap Plan C if you were born in or before 1954. Exceptions include those born after 1954 but became eligible for Medicare before 2020.
In addition, you must be enrolled in Medicare Parts A and B to join a Medigap plan. Those enrolled in Medicare Advantage cannot join a Medigap plan.
What Does Medigap Plan C Cover?
Medigap plans don’t add coverage for health services, but instead help cover your out-of-pocket expenses from Original Medicare. For instance, every Medigap plan takes care of your Part A coinsurance and hospital costs for up to 365 days after Medicare’s coverage ends.
Here’s what Medigap Plan C also includes:
- Part B deductible and coinsurance
- Skilled nursing coinsurance
- Medically necessary emergency health care for the first 60 days if traveling outside of the country
Costs For Medigap Plan C
When choosing a Medigap plan, it’s essential to consider both your current health needs and what you might need in the future. You’ll also want to keep the costs in mind, such as:
- Premiums: This is the amount paid monthly for Medigap Plan C, in addition to your Original Medicare premiums.
- Deductibles: This is the amount you must pay out of pocket on covered care before your Medigap plan helps with cost sharing.
- Copays: Occasionally, you’ll have a set fee to pay when receiving a Medicare service. However, Medigap Plan C takes care of all your Original Medicare copays.
- Coinsurance: This is a percentage of the medical cost you pay after the deductible has been met. For example, without Medigap, you would be responsible for 20% of costs under Part B. With Medigap Plan C, that entire 20% is covered.
See It In Action
Let’s explore how Medigap Plan C may look, but keep in mind that your actual costs of Medigap Plan C depend on your specific plan’s details.
Consider a scenario where you have Original Medicare and go to see a specialist, such as a cardiologist. Your doctor charges $200 for the appointment, but you have not met your Part B deductible yet because it is early in the year.
Without Medigap Plan C, you would pay for the appointment cost out of pocket until you meet your deductible. But with Medigap Plan C, your Medigap plan would step in and cover this cost.
How Medicare Supplement Plan C Compares With Other Comprehensive Medigap Plans
| Benefits | Plan C | Plan F | Plan G |
|---|---|---|---|
| Available to those who became eligible for Medicare in or after 2020? | No | No | Yes |
| Part A coinsurance and hospital costs for up to 365 additional days after Medicare benefits are disbursed | Yes | Yes | Yes |
| Part B coinsurance or copayment | Yes | Yes | Yes |
| Part A hospice care coinsurance or copayment | Yes | Yes | Yes |
| Part A deductible | Yes | Yes | Yes |
| Part B deductible | Yes | Yes | Not covered |
| Part B excess charge | Not covered | Yes | 100% |
| Out-of-pocket limit | N/A | N/A | N/A |
| Blood (first three pints) | Yes | Yes | Yes |
| Skilled nursing facility care coinsurance | Yes | Yes | Yes |
| Foreign travel exchange up to plan limits | 80% | 80% | 80% |
How to Choose a Medigap Plan
If you enroll in Original Medicare and want a supplemental plan to help cover leftover out-of-pocket costs, how do you know which plan to choose? Consider the following when shopping for a Medigap plan:
- Your coverage needs. Medigap plans vary in what costs they do and do not cover from Original Medicare. Typically, the more coverage provided, the higher the monthly premium. Think through what benefits you are most likely to use and prioritize Medigap plans that can help cover those costs.
- Rates. Compare rates from multiple private insurance companies that offer your preferred Medigap plan. As benefits are standardized across all Medigap plans of the same letter — for example, all Medigap Plan C plans must offer the same benefits no matter the insurance carrier — look through the differing rates.
- Reputation. Explore an insurance carrier’s overall reputation for customer satisfaction. Asking others who have the same plan may help you gain insight into whether it is a good fit for your needs.
How to Enroll in a Medigap Plan
Once you have determined which lettered Medigap plan to purchase, it is time to enroll. You may enroll in Medigap at any time of the year when you have Original Medicare, but enrolling during your initial Medigap open enrollment period is the best option to ensure the widest selection and lowest premiums.
This period starts that month you enroll in Medicare Part B and continues for 6 months. After this period, you can still enroll in Medigap but medical underwriting may affect the premium cost and your plan choices.
Those specifically looking to enroll in Medigap Plan C must meet eligibility criteria. If you do, you can find a Medigap Plan C plan by directly contacting an insurance company in your state offering the plan, working with your State Health Insurance Assistance Program (SHIP), or connecting with a licensed insurance agent.
Putting It All Together
Medigap Plan C helps cover your out-of-pocket costs for medical and skilled nursing care from Original Medicare. While it is one of the most comprehensive Medigap plans, it is also no longer widely available. Medigap Plan C is only available to those who were eligible for Medicare before January 1, 2020. Work with a trusted licensed insurance agent or broker to help better understand your Medigap options.
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