Medigap Plan C is one of the most comprehensive of the 10 standardized Medigap insurance plans available in most states. Out of the 10, only Medigap Plan F offers more coverage. Medigap Plan C covers most Medicare-approved out-of-pocket expenses.

Unfortunately, Medicare Supplement Plan C is being phased out, along with Plan F. Be aware that if you become eligible for Medicare on or after January 1, 2020, you won’t be able to buy Plan C. If you already have Plan C, don’t worry you can generally keep your plan. You can apply to buy Plan C if you become eligible for Medicare before 2020.

Medigap Plan C is not the same as Medicare Part C (Medicare Advantage), even though their names sound somewhat alike.

Medicare Supplement insurance Plan C typically covers the following:

  • Medicare Part A hospital coinsurance and hospital costs up to 365 days after Original Medicare benefits are exhausted
  • Medicare Part A hospice care coinsurance or copayments
  • Medicare Part B copayments and coinsurance
  • First three pints of blood for a medical procedure
  • Skilled Nursing Facility care coinsurance
  • Medicare Part A deductible
  • Medicare Part B deductible
  • Foreign travel emergency coverage (80% of approved costs up to plan limits)

Medigap Plan C does not cover?

It doesn’t cover Medicare Part B excess charges. These are doctor charges that can legally extend beyond the Medicare-approved amount for service payment. When excess charges occur, the remainder of the cost is charged directly to the patient. For example, a doctor or physician may be allowed to bill up to 15% over the Medicare-approved amount in some cases.

Medicare Supplement insurance Plan C costs

Medicare Supplement insurance plans are sold by private insurance companies, so premiums may vary. However, every Medigap Plan C policy must include the same basic benefits.

When to enroll in Medicare Supplement insurance Plan C

If you sign up for a Medigap Plan C policy during your six-month Medigap Open Enrollment Period (OEP), in most cases the insurance company must accept your application and can’t charge you more if you’re in poor health, nor impose a waiting period even if you have a pre-existing condition.

Your Medigap OEP starts the month that you’re both at least 65 years old and enrolled in Medicare Part B. You must live within the plan’s service area. If you apply for Medigap Plan C outside your Medigap OEP, the insurance company may require you to undergo medical underwriting and doesn’t have to accept you as a member. However, in some situations, you might have a guaranteed issue right to enroll in a Medigap plan. Availability and plan costs may vary.

Pre-existing conditions are generally health conditions that existed before the start of a policy. They may limit coverage, be excluded from coverage, or even prevent you from being approved for a policy; however, the exact definition and relevant limitations or exclusions of coverage will vary with each plan, so check a specific plan’s official plan documents to understand how that plan handles pre-existing conditions.

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