Understanding Medicare Supplement (Medigap) Plan C Coverage and Costs
There are a couple notes to consider before diving into Medicare Supplement (also called Medigap) Plan C and what it entails.
First, Medicare Supplement Plan C is not available for anyone that has turned 65 on or after January 1, 2020.
It’s also important to understand the difference between Medicare Part C and Medicare Supplement Plan C. They are two different types of coverage. Medicare Part C, also known as Medicare Advantage, is a bundled, private alternative to Original Medicare.
Medicare Supplement Plan C is an option for Medigap insurance. It covers out-of-pocket expenses related to Part A and Part B and travel-abroad emergency medical care. Read on to learn more details about Medigap and Plan C.
Key takeaways:
Medicare Supplement Plan C covers Original Medicare costs and travel-abroad emergency medical care.
Medicare Supplement Plan C does not cover Part B excess charges.
Medicare Supplement Plan C is not available for anyone who has turned 65 after January 1, 2020.
Medicare is not one-size-fits-all. We recommend speaking with one of our licensed Medicare Advisors to choose the right Medicare coverage for your unique needs.
What are Medicare Supplement plans?
When Medicare was established, beneficiaries found that they still had to pay quite a bit for common services and treatments. Original Medicare only pays for 80% of covered services. Medigap policies were introduced to fill in the “gaps” left from Original Medicare and cover some of the remaining 20% of costs.
Benefits of Medicare Supplement plans
If you have Original Medicare, Medigap is beneficial for increased coverage to limit your out-of-pocket costs. Supplement plans help pay for deductibles, copayments, and coinsurance.
Medicare Supplement plans are also appealing because they have great benefits you won’t get with Medicare Advantage plans. These benefits are:
Standardization
All Medigap plans of the same type are identical in coverage even if pricing is different. For example, all Plan Cs would provide the same benefits regardless of the premiums you pay. There are a variety of different factors that go into pricing (which we’ll discuss later), but the standardization of Medigap plans makes it easier to choose the right plan.
No restrictive provider networks
Compared to Medicare Advantage, Original Medicare and Medicare Supplement allow you to see any medical professional who accepts Medicare, which is about 90% of providers nationwide. This is especially beneficial for anyone who travels a lot and needs coverage in more than one state.
No need for prior authorization
One drawback of Medicare Advantage is that they often require prior authorization for covered services. If you are denied prior authorization, you would be responsible for 100% of the costs of the treatment. With Original Medicare and Medigap, you don’t need prior authorization for any covered services.
Eligibility for Medicare Supplement plans
You are eligible for a Medicare Supplement plan if you are:
Enrolled in Original Medicare (Part A and Part B).
Not enrolled in Medicare Advantage.
As a reminder, if you turn 65 after January 1, 2020, you are not eligible for Medicare Supplement Plan C. This also applies to Medicare Supplement Plan F.
Comparing Medicare Supplement plans
There are ten types of Medicare Supplement plans, lettered A through N. Each plan covers a different set of out-of-pocket costs. Take a look at this chart to learn the difference between each plan.
Understanding the different parts and plans of Medicare can feel complicated. If you need help comparing different plans and choosing the right one for you, our licensed Medicare Advisors are here to help! Give us a call at (855)-900-2427 for free advice tailored to you.
Medicare Supplement Plan C coverage
In 2023, about 3% of Medicare Supplement beneficiaries were enrolled in Medigap Plan C (compared to 32% on Plan G). Because Plan C is longer available to adults who turned 65 after January 1, 2020, it will become less and less common. Currently, Plan G is the most popular Medigap plan among new Medicare enrollees.
Important note: Massachusetts, Minnesota, and Wisconsin offer a different set of standardized Medicare Supplement plans. These states do not offer a Medigap Plan C.
What’s covered under Medigap Plan C?
Medigap Plan C covers:
Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up
Part B coinsurance or copayment
Blood transfusion (first 3 pints)
Part A hospice care coinsurance or copayment
Skilled nursing facility care coinsurance
Part A deductible
Part B deductible
Plan C also covers 80% of foreign travel exchange, which means you can get medical emergency care when traveling abroad within the first 60 days of your trip (with a lifetime limit of $50,000).
What’s not covered?
Medigap Plan C does not cover Part B excess charges. You will be responsible for this out-of-pocket expense when a Medicare provider charges more than the Medicare-approved amount. This can happen when providers charge more than what is allowed by Medicare.
In general, Medigap only provides coverage for out-of-pocket costs leftover by Original Medicare. It will not cover additional healthcare needs like:
Long-term care and private nurses
Dental care
Routine eye exams and glasses
Prescription drugs
Medicare Supplement Plan C costs
Medicare Supplement plans are beneficial because they provide you with more comprehensive coverage and better financial predictability. With Original Medicare and a Medigap Plan C, your out-of-pocket costs will include:
Original Medicare premiums
Part B excess charges
How much you pay for your specific Medigap plan will depend on personal factors, where you live, and your insurance carrier.
Medicare Supplement Plan C premiums
Medicare determines your Plan C premium based on the following factors:
Where you live
Your smoking status
Your age
Your gender
The insurance carrier
Household discounts (offered by some Medigap plans)
Will my Medicare Supplement premium change over time?
There are three pricing or “rating” structures that determines how your Medicare Supplement premiums could change over time depending on your plan:
Community-rated (aka no-age-rated): The premium you pay is the same as everyone else with the same policy, regardless of age. This means your premium will not increase as you age.
Issue-age-rated (aka entry age-rated): The premium you pay is based on the age you were when you first enrolled in your Medigap plan. Your premium can increase due to inflation and other factors, but not due to age.
Attained-age-rated: The premium you pay is based on the age you currently are (the age you’ve “attained”). Your premium can increase as you get older.
Medicare Supplement Plan C deductibles
There is no Plan C deductible, and if you’re enrolled in a Medigap Plan C, your Part A and Part B deductibles are eliminated.
Medicare Supplement Plan C out-of-pocket costs and maximums
With Plan C, you are responsible for paying Part B excess charges. If your treatment costs more than what Medicare accepts, you will need to pay out-of-pocket. You can avoid these charges by checking with your provider’s billing department ahead of receiving services.
How to enroll in a Medicare Supplement Plan C
If you turn 65 after January 1, 2020, you can’t enroll in a Medigap Plan C, but there are other great Medigap plans to choose from! We often recommend enrolling in a Medigap Plan G, which provides a similar coverage at a great value. Coverage is the same as Plan C except for two things. With a Medigap Plan G:
You’re responsible for your Part B deductible.
Part B excess charges are covered.
How to choose the right Plan C
Because all Plan Cs have the same coverage, you can focus on premiums and insurance carriers. Our Medicare Advisors will help you understand each option, provide information on insurance carriers’ customer service, and compare premiums to help you choose the best Medigap plan C for your needs.
Get started today: schedule a free consultation or call us at (855) 900-2427.