- Medigap Plan C is a supplemental insurance coverage plan, but it’s not the same as Medicare Part C.
- Medigap Plan C covers a range of Medicare expenses, including the Part B deductible.
- Since January 1, 2020, Plan C is no longer available to new Medicare enrollees.
- You can keep your plan if you already had Plan C or if you were eligible for Medicare before 2020.
You may know that there were changes to Medigap plans beginning in 2020, including Medigap Plan C. Starting on January 1, 2020, Plan C was discontinued. If you have Medicare and a Medigap supplement plan or are getting ready to enroll, you might be wondering how these changes affect you.
The first thing you should know is that Plan C is not the same as Medicare Part C. They sound similar, but Part C, also known as Medicare Advantage, is a completely separate program from Medigap Plan C.
Plan C is a popular Medigap plan because it offers coverage for many of the costs associated with Medicare, including the Part B deductible. Under the new 2020 rules, if you were already enrolled in Plan C, you can keep this coverage.
However, if you’re new to Medicare and were considering Plan C, you won’t be able to purchase it. The good news is there are many other Medigap plans available.
In this article, we’ll talk about why Plan C went away and which other plans may be a good fit for you instead.
In 2015, Congress passed legislation called the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). One of the changes made by this ruling was that Medigap plans are not allowed to provide coverage for the Part B deductible. This rule went into effect on January 1, 2020.
This change was made to discourage people from visiting a doctor’s office or hospital when it wasn’t necessary. By requiring everyone to pay out of pocket for the Part B deductible, Congress hoped to cut down on visits for minor ailments that could be handled at home.
Plan C is one of two Medigap plan options that covered the Part B deductible (the other was Plan F). This means that it can no longer be sold to new enrollees due to the new MACRA rule.
You can keep your Plan C if you already have it. As long as you were enrolled before December 31, 2019, you can keep using your plan.
Unless the company you have decides to no longer offer your plan, you can hang onto it for as long as it makes sense for you. Additionally, if you became eligible for Medicare on or before December 31, 2019, you can also still enroll in Plan C.
The same rules apply to Plan F. If you already had it, or were already enrolled in Medicare before 2020, Plan F will be available to you.
Plan C won’t be available to you if you’re newly eligible for Medicare in 2021. You still have many other options for Medigap plans that cover many of your Medicare expenses. However, those plans cannot cover the Part B deductibles costs, per the new rule.
What does Medigap Plan C cover?
Plan C is very popular because of how comprehensive it is. Many Medicare cost-sharing fees are covered under the plan. In addition to coverage for the Part B deductible, Plan C covers:
- Medicare Part A deductible
- Medicare Part A coinsurance costs
- Medicare Part B coinsurance costs
- hospital coinsurance for up to 365 days
- the first 3 pints of blood needed for a procedure
- skilled nursing facility coinsurance
- hospice coinsurance
- emergency coverage in a foreign country
As you can see, nearly all costs that fall to Medicare beneficiaries are covered with Plan C. The only cost that isn’t covered by Plan C is what’s known as the Part B “excess charges.” Excess charges are an amount above the Medicare-approved cost billed by a healthcare provider for a service. Excess charges aren’t allowed in some states, making Plan C a great option.
What other comprehensive plans are available?
There are a variety of Medigap plans available, including Plan C and Plan F. If you can’t enroll in either of those because you weren’t Medicare-eligible before 2020, you have a couple of options for similar coverage.
Popular choices include Plans D, G, and N. They all offer similar coverage to Plans C and F, with a few key differences:
- Plan D. This plan offers all of the coverage of Plan C except for the Part B deductible.
- Plan G. All costs except the Part B deductible are also covered under this plan.
- Plan N. Under Plan N, all of your costs are covered with a few exceptions. The Part B deductible isn’t covered, and you’ll be responsible for some copayments. Under Plan N, you’ll pay up to $20 for some office visits and up to $50 for emergency room (ER) visits that don’t result in hospital admission.
The following chart compares the details of each of these plans more closely:
| Plan C | Plan D | Plan G | Plan N | |
|---|---|---|---|---|
| Part A deductible | yes | yes | yes | yes |
| Part B deductible | yes | no | no | no |
| Part A hospital coinsurance | yes (up to 365 days) | yes (up to 365 days) | yes (up to 365 days) | yes (up to 365 days) |
| Part A hospice coinsurance | yes | yes | yes | yes |
| Part A skilled nursing facility coinsurance | yes | yes | yes | yes |
| Part B coinsurance and copayments | yes | yes | yes | yes(with a $20 doctor visit copay and $50 ER copay) |
| Foreign travel coverage | 80% | 80% | 80% | 80% |
| Part B excess charges | no | no | yes | no |
Is there a cost difference between plans?
Plan C premiums tend to be slightly higher than monthly premiums for Plans D, G, or N. Your costs will depend on where you live, but you can check out some sample costs from around the country in the chart below:
| City | Plan C | Plan D | Plan G | Plan N |
|---|---|---|---|---|
| Philadelphia, PA | $151–$895 | $138–$576 | $128–$891 | $88–$715 |
| San Antonio, TX | $120–$601 | $127–$529 | $88–$833 | $70–$599 |
| Columbus, OH | $125–$746 | $106–$591 | $101–$857 | $79–$681 |
| Denver, CO | $152–$1,156 | $125–$693 | $110–$1,036 | $86–$722 |
Depending on your state, you might have more than one Plan G option. Some states offer high-deductible Plan G options. Your premium costs will be lower with a high-deductible plan, but your deductible could be as high as a few thousand dollars before your Medigap coverage kicks in.
Medigap plans can help you pay the costs associated with Medicare. There are 10 plans available, and Medicare requires them to be standardized no matter which company offers them. The exception to this rule are plans offered to residents of Massachusetts, Minnesota, or Wisconsin. These states have different rules for Medigap plans.
However, Medigap plans don’t make sense for everyone. Depending on your budget and healthcare needs, paying an additional deductible might not be worth the benefits.
Also, Medigap plans don’t offer prescription drug and other supplemental coverage. For example, if you have a chronic condition that requires a prescription, you might be better off with a Medicare Advantage Plan or Medicare Part D plan.
On the other hand, if your doctor has recommended a procedure that will require a hospital stay, a Medigap plan that covers your Part A deductible and hospital coinsurance might be a smart move.
Medigap pros:
- nationwide coverage
- coverage for many medicare costs
- additional 365 days of hospital coverage
- some plans offer coverage while traveling abroad
- some plans cover extras like fitness programs
- wide range of plans to choose from
Medigap cons:
- premium costs can by high
- prescription drug coverage is not included
- dental, vision, and other supplemental coverage is not included
You can shop for Medigap plans in your area using a tool on the Medicare website. This tool will show you the plans available in your area and their prices. You can use that tool to decide if there is a plan that meets your needs and budgets.
For more help, you can contact your State Health Insurance Assistance Program (SHIP) to get advice for picking a plan in your state. You can also contact Medicare directly for answers to your questions.
Medigap Plan C is a popular supplement option because it covers so many of the out-of-pocket costs associated with Medicare.
- Starting on January 1, 2020, Plan C was discontinued.
- You can keep Plan C if you already have it.
- You can still enroll in Plan C if you were eligible for Medicare on or before December 31, 2019.
- Congress has ruled that the Plan B deductible can no longer be covered by Medigap plans.
- You can purchase similar plans without the Plan B deductible coverage.
- Similar plans include Medigap Plans D, G, and N.
Medicare plan options and costs are subject to change each year.