Medicare Supplement Plan C
Medicare Supplement Plan C is a popular Medigap Plan that pays most healthcare costs not covered by Original Medicare.
After Original Medicare pays its portion of medical costs, beneficiaries can have many out of pocket costs. Such as copayments, deductibles, co-insurance.
In addition to the above out of pocket costs, Medicare Part B also leaves you responsible for 20% of your medical bill. That’s where Medicare Supplement Plan C steps in to help.
Medicare Supplement Plan C: What You Need to Know in 2020
Plan C is one of the most comprehensive plans available. Plan C and Medigap Plan C are the same things.
Medigap Plan C is often mistaken with Medicare Part C, also known as Medicare Advantage, but the two are very different. Medigap Plan C is supplemental insurance for people who have Original Medicare.
Medicare Part C is a private health insurance alternative to Original Medicare. If you have a Medicare Advantage Plan, you cannot enroll in a Medigap Plan.
Beneficiaries eligible for Medicare on or after January 1, 2020, won’t have access to Medigap Plan C. Guarantee Issue rights are the same; beneficiaries newly eligible can’t elect Plan C after 2020, even when losing coverage.
Newly eligible beneficiaries can enroll in Plans D or G with GI rights when losing coverage.
Beneficiaries eligible for Medicare before 2020 are eligible for Plan C enrollment. Also, when involuntarily losing creditable coverage, those eligible for Medicare before 2020 CAN select Plan C with GI rights after 2020.
However, beneficiaries eligible for Medicare prior to 2020 can’t select Plans D or G with GI rights.
It’s always best to consult a licensed Medicare expert about eligibility. Our brokers are trained to identify your eligibility status.
Plan C is Considered First- Dollar Coverage
There are 3 Medigap Plans that fall under the category of first-dollar coverage plans, Plan C is one of them. All first-dollar coverage means is you pay nothing out of pocket.
Any medical costs left up to the beneficiary to pay after Original Medicare pays their portion will be billed to your carrier. Thus, leaving you with zero out of pocket costs.
Medigap Plan C Benefits
Medigap Plan C benefits include all of the following:
- Up to an additional 365 days in the hospital after Original Medicare benefits run out
- Coinsurance (usually 20 percent) and copayments for doctor visits and other Medicare Part B services
- Coinsurance for hospice or skilled nursing care
- The first three pints of blood for a medical procedure
- The Medicare Part A deductible
- The Medicare Part B deductible
- Foreign travel emergencies, up to plan limits
The only benefit Plan C does not include is coverage for any excess charges that fall under Part B. Excess charges are costs that extend above the Medicare-approved amount for that service.
A doctor or physician can charge up to an additional 15% over the Medicare-approved amount. They bill these excess charges directly to the beneficiary.
However, not many doctors have excess charges. A quick phone call to your physician will let you know if they accept the Medicare-approved amount for their services.
If you’re not concerned about excess charges, most Medicare beneficiaries are not, then Plan C will leave you with $0 out of pocket costs.
Plan C, as well as all Medigap Plans, give you the option to choose any doctor. You can see a specialist at any time with no referral. You won’t need to worry about a cancelation due to health issues.
Plan C is Great for Beneficiaries Who:
- Semi-frequently visit the doctor and/or hospital
- Travel overseas
- Are switching to another Medigap plan with guaranteed issue rights outside of their Initial Enrollment Period
How Coverage Works
If Emily has a Plan C, her policy will cover most of the gaps in Medicare. The only coverage responsibility Emily has is the Part B excess charges. Most doctors accept Medicare, so excess charges aren’t usually a concern.
So, if Emily goes to the hospital then her Part A deductible has coverage as well as the Part A coinsurance charges. Basically, Emily pays nothing when she’s receiving inpatient hospital care. However, Part B can require some out of pocket funding.
So, when Emily goes to a doctor that charges an extra amount, that amount can’t be more than 15% over Medicare’s amount. Plan C can be an incredible option for people looking to make smart Medigap choices.
Anyone with Medicare Part B is eligible. It’s easiest to qualify for coverage if you enroll during your six-month Open Enrollment Period. Your Medicare Supplement Open Enrollment Period begins as soon as your Part B is in effect.
If you enroll during this time, you automatically qualify for a policy. A beneficiary can’t be rejected or forced to pay higher rates because of pre-existing health conditions. This is because you’re granted Guaranteed Issue.
If your Open Enrollment Period has passed, your policy will be “medically underwritten.” This just means you’ll have to answer some health questions during the application process.
However, you can enroll in Plan C at any time. Even if your one time Open Enrollment Period has come and gone.
If you didn’t sign up for Part B because you still had employer health insurance when you turned 65, your six-month Open Enrollment Period will begin the month you sign up for Part B.
If you’re on disability and under 65, eligibility will depend on the state where you live.
Plan C is one of the most comprehensive supplement plans available. Since it includes almost all the benefit options, it’s one of the more costly plans.
However, if you value peace of mind, then the benefits will outweigh the costs. Most Medicare beneficiaries don’t mind paying a little more to feel financially secure with it comes to their healthcare costs.
For beneficiaries that don’t have Medigap Plan, paying 20% out of pocket on a medical bill that could be thousands of dollars or more could financially ruin them.
For example, let’s say you’re diagnosed with diabetes. After multiple visits to the doctors’ office for various tests, you find out you need diabetic supplies such as glucose monitors and test strips. Don’t forget the insulin! You also need routine foot and eye exams.
Lets’ say the total costs of all your doctors’ visits and various tests came to $20,000. Then the total costs of your diabetic supplies came to another $20,000. After Medicare pays its 80% of $40,000, you’re left with the remaining $8,000 to pay out of pocket.
However, if you have Plan C, you’ll have coverage on that $8,000. Let’s not forget coinsurance & co-pays for routine foot and eye exams. Any leftover costs from these will also be covered by Plan C.
Therefore, the only cost for Medicare Plan C is the monthly premium.
You will pay a monthly premium for Plan C coverage. Your premium amount depends on where you live, the carrier you choose, your plan’s rate structure, your age, gender, etc.
Regardless of the carrier you choose, the benefits will always remain the same. The only difference is the premium the carrier charges for the supplement plan. That’s why it’s important to have a licensed agent by your side when comparing rates.
The average premium for Medicare Plan C is around $150 per month. Again, the premium varies based on many factors. It could be less or more, depending on your location, age, etc. Just because your neighbor pays X premium for a supplement plan does not mean you’ll pay the same.
Medicare Plan C is Going to Be Discontinued in 2020
Some have heard that first-dollar coverage plans are retiring in 2020. This is true, but there are important facts to know about this change.
First-dollar coverage insurance plans include Plan C, Plan F & High-Deductible Plan F. The plans are being discontinued due to beneficiaries going to the doctors more than necessary. Since they had no out of pocket costs, going for minor medical issues was no big deal.
Well, it was apparently a big deal to Medicare. To reduce these unnecessary doctor visits, they wanted to make beneficiaries responsible for some out of pocket costs, even if it’s just the Part B deductible.
You Can Still Enroll in Medicare Plan C After 2020
The discontinuation of first-dollar coverage plans will only impact beneficiaries that become Medicare “eligible” after 2020. This means, as long as you turned 65 before 2020, you can still enroll in Medicare Plan C after 2020.
For example, if you turned 65 sometime in August of 2019, but did not enroll in Part B until sometime in 2020, you can still enroll in one of the three first-dollar plans.
Therefore, regardless if you turned 65 in 1994, 2005 or 2019, you can still enroll in these plans after 2020.
If you don’t want to enroll in Plan C for one reason or another, then Plan G is the best alternative supplemental insurance. The only difference between Plan C and Plan G is coverage for your Part B Deductible.
If you’re not eligible for Medicare until after 2020, but want similar benefits to first-dollar coverage plans, then Medigap Plan G is your best option. Plan G is not going anywhere in 2020 and on average costs a little less than Plan C.
You can find tons of FAQs for Medigap plans here.
Compare Plan C Rates
We can provide you with rates for Plan C from the top-rated insurance companies in your area.
We’ll answer your questions and help you complete the online enrollment process.
Since Medicare is always changing, it’s important to have a licensed agent by your side.
To begin the process call us; or, you can use our online rate comparison tool to see a side by side comparison of rates in your area now.