Medigap Plan C 

Not to be confused with Medicare Part C, Medicare Supplement Plan C, or Medigap Plan C, is one of the most comprehensive of the 10 Medigap Plans. However, you can only buy Plan C if you were eligible for Medicare prior to 2020.  As a supplemental plan, Medigap Plan C helps cover almost all the costs not covered by your Original Medicare Part A and Part B.

What Does Medigap Plan C Cover?	Jump to
What’s Not Covered by Medigap Plan C?	Jump to
Why was Medigap Plan C Retired?	Jump to
Medigap Plan C vs Medicare Part C	Jump to

What does Medigap Plan C Cover?

As one of the most comprehensive Medigap plans, Plan C covers 8 out of the 9 standard Medigap benefits, including:

• Medicare Part A coinsurance & hospital costs 
• Medicare Part B coinsurance or copayments 
• First 3 pints of a blood transfusion 
• Part A hospice care coinsurance or copayments 
• Skilled nursing facility care 
• Medicare Part A deductible 
• Medicare Part B deductible 
• Foreign travel emergency care 

The 8 standard Medigap Plan C benefits explained:

1. Medicare Part A coinsurance and hospital costs
   Medigap Plan C covers your Part A coinsurance and hospital costs for days 61 through 150. In addition, this benefit covers up to 365 more hospital days after your Medicare benefits are used up.ⁱ  
   
   Note: Typically, Medicare Part A coinsurances don’t kick in until after you’ve paid your deductible for the year,
   but since Medigap Plan C covers your Part A deductible, you don’t have to pay anything. 
2. Skilled nursing facility care
   Original Medicare pays all your skilled nursing care costs for the first 20 days. Typically, you’re responsible for paying for any days after that. Medigap Plan C pays your share for days 21 through 100.  
   
   Note: Neither Original Medicare nor Medigap plans pay for any skilled nursing care longer than 100 days.
3. Part B coinsurance or copayment
   Medigap Plan C covers your Part B coinsurances and copayments, which are typically 20% of the Medicare-approved amount for most doctor services, outpatient therapy, and durable medical equipment.ⁱ 
   
   Note: Medicare Part B coinsurances and copayments don’t kick in until after you’ve paid your Part B deductible. With Medigap Plan C, you are still required to pay your Part B deductible. ⁱ   
4. First 3 pints of a blood
   Medigap Plan C covers the first three prints of blood per year. ⁱ  
5. Part A hospice care coinsurance or copayment
   Medigap Plan C covers your 5% coinsurance for palliative drugs and respite care under the Part A hospice benefit. ⁱ  
6. Medicare Part A deductible
   Original Medicare Part A charges deductibles per benefit period before your Medicare benefits can kick in. In 2022, the Part A deductible is $1,556ⁱⁱ. Medigap Plan C covers this cost for you.
7. Medicare Part B deductible
   Original Medicare Part B charges a deductible per year before your Medicare benefits can kick in. In 2022, the Part B deductible is $233.ⁱⁱ Medigap Plan C covers this cost for you.
8. Foreign travel care
   Original Medicare doesn’t typically cover health care while you’re traveling abroad. However, Medigap Plans C will cover up to 80% of covered foreign travel emergency care if it begins during the first 60 days of your trip.ⁱⁱⁱ  

What’s Not Covered by Medigap Plan C?

As one of the more comprehensive plans, there is only one standard benefit that Medigap Plan C does NOT cover: Medicare Part B excess charges. 

Medicare Part B excess charges happen when a doctor bills you more than what Medicare thinks a procedure is worth. Doctors in most states are allowed to charge you up to 15% more than the Medicare approved amount.

Regardless of which Medigap Plan you buy, it will not cover:

• Routine dental, vision or hearing services
• Eyeglasses or contacts
• Hearing aids
• Long-term care or custodial care
• Prescription drugs

How Much Does Medigap Plan C Cost?

Like any Medigap Plan, Plan C comes with monthly premiums. These premiums are set by the insurance company selling the plan and can vary widely by region. There are also several other factors that impact rates like your age, your gender, whether you use tobacco products, if you qualify for any discounts and more. 

It’s best to compare Medigap plans in your area from as many insurance companies as possible. Carriers can offer the same exact plans at different rates. So, comparison shopping will help you find the best rate available to you.   

Note: You’ll still be responsible for paying your monthly Medicare Part A and Part B premiums – although most people don’t have Part A premiums. Make sure to factor in these costs when considering Medigap premiums. 

Why Was Medigap Plan C Retired?

Medigap Plan C is being phased out and is no longer available to anyone joining Medicare after January 1, 2020. Congress voted to retire Plan C – along with Plan F (including high-deductible Plan F) – because these plans covered the Part B deductible. The decision was made in an effort to reduce medical overuse.  

If you turned 65 before 2020, then you are grandfathered in and are able to keep your Plan C or Plan F as well as enroll into a Plan F or Plan C for the first time.

Medigap Plan C vs Medicare Part C: Are they the same?

Medigap Plan C and Medicare Part C are not the same thing. People often confuse the two because the names are so similar, but it’s important to understand the difference.  

The Medicare program consists of Part A, Part B, Part C and Part D. Part C combines your Parts A and B, and sometimes Part D, to make an all-in-one Medicare health insurance plan called Medicare Advantage. When talking about Part C, it’s always in reference to Medicare Advantage.  

Medigap Plans, on the other hand, supplement Original Medicare. Because, Medicare Advantage Plans replace Original Medicare, you can’t have a Part C plan and a Medigap plan at the same time.

Is Medigap Plan C Right for Me?

Whether Medigap Plan C is right for you is going to depend on your health status, budgetary restrictions and lifestyle. It’s also going to depend on how often you visit the doctor, whether you travel abroad, if you can afford to pay more up front for your healthcare in turn for less out-of-pocket costs and more. It’s also going to depend on where you live. For example, if your state allows Part B excess charges, you may want to consider a different Medigap Plan that covers these.

A Medigap Plan C might be right for you if you:

• Were eligible for Medicare before 2020
• Visit the doctor and/or hospital semi-frequently
• Live in a state that doesn’t allow Part B excess charges

There are a few plans that are more popular than others, including a couple that are gaining in popularity since Plans C and F were discontinued for new enrollees. You can learn more about the top Medigap plans here.  

If you need help determining which plan is best for you, Ensurem has licensed agents ready to answer your questions. They can also help you compare Medigap plans available in your area from some of the nation’s top-rated carriers.  

Education is crucial in finding the right Medicare solution for you. With so many Medicare resources out there,
it can be difficult finding a source you can trust. That’s why Ensurem has a Compliance Program dedicated to ensuring our Medicare content meets CMS regulations. So, you can rest assured you’re getting the information you need to make the right coverage decisions. Learn more here.