Medicare Supplement Plan C

By: Meredith Miller
Published: Thursday, July 26 2018
Last Updated: 4 years ago

Medicare provides seniors with the security of knowing that their primary health-related needs are met. But it was not designed to pay for all probable medical expenses, so there are some gaps in coverage.

In order to fill these gaps, Medicare Supplement Plan C, also known as Medigap Plan C, was created to ensure seniors receive more necessary benefits from their health insurance services. The major advantage of Medicare Supplement Plan C is that it covers most out-of-pocket costs.

What is Medicare Plan C?

Medicare Plan C provides supplemental health-related services offered by private insurance companies. It helps pay for the services not covered under Part A and B. Medicare Plan C coverage distinguishes itself from other plans by assisting with more expenses like extended care.

Medigap Plan C is offered in most states but is not connected to the United States government. However, all Medigap policies are standardized and must adhere to state and federal guidelines that function to protect consumers. It's important to remember that Medicare Plan C coverage is not the same as Medicare Part C, also known as Medicare Advantage.

What Medicare Supplemental Plan C Covers?

Medigap Plan C is the most inclusive of the 10 standard Medigap plans. Plan C covers the hospital and medical expenses from Parts A and B while providing some of the additional health care costs that seniors typically experience. There are many medical expenses that Medicare doesn't cover, yet, Medicare Supplemental Plan C will help with the cost of the following benefits:

  • Plan A coinsurance hospital expenses up to 365 days after Medicare benefits are depleted
  • Skilled nursing care coinsurance
  • Part B coinsurance payment for preventative care
  • Part A hospice care copayment or coinsurance
  • Foreign emergency travel coverage (covers 80% of approved costs up to plan limits)
  • First three pints of blood for a medical procedure
  • Part B coinsurance payment or copayment

There are no restrictive networks with Medicare Plan C coverage. You have the flexibility of choosing any physician, specialist, and hospital that accepts Medicare without pre-certifications or pre-approvals. Medicare Plan C also pays for costly inpatient and outpatient deductibles.

What Doesn't Medicare Plan C Cover?

Medicare Supplemental Plan C doesn't cover the excess charges from Part B. Excess charges are the doctor or hospital expenses that exceed Medicare's approved amount for care. When excess charges occur, the difference is billed to the patient. These excess charges cannot go beyond 15% of what Medicare pays.

Medigap Plan C has benefits that are very similar to Plan F, however, although the latter has a high deductible plan, it does cover excess charges. None of the Medigap plans provide prescription drug coverage. Individuals who choose this plan will need to enroll in a stand-alone prescription drug plan.

Medicare Supplement Plan C Cost

Because Medicare Supplemental Plan C services are offered by private insurance companies, the prices will vary. These companies decide on the premium price for Medicare Supplemental Plan C policies. The type of formula they use to determine the cost will affect how much you pay. Medigap Plan C prices fall into three categories.

  • Community-rated (no-aged): Everyone has the same premium regardless of age
  • Issue-age-rated (entry age-rated): Premium is based on the age of policyholder when the plan was purchased
  • Attained-age-rate: Premium goes up as policyholder gets older

Medicare Supplement Plan C premiums can vary widely depending on the pricing model used by the insurance companies. The premiums can also depend on variables such as discounts for women, non-smokers discounts, yearly payments, and holders of multiple policies.

Who Should Consider Medicare Plan C?

Individuals close to 65 years of age should carefully consider applying for Medicare Supplement Plan C since the plan will no longer be offered as of 2020. People who have medical needs that generate costly expenses that are not covered by Medicare Part A & B could benefit from Medicare Plan C coverage. Seniors who enjoy traveling may also find the Medicare Plan C option valuable.

In order to qualify for Medicare Supplemental Plan C coverage, you must be enrolled in Medicare Parts A and B. The 6-month Open Enrollment for Medicare Plan C starts during the month you turn 65 years old.

During this period, insurance companies cannot penalize you for poor health or pre-existing conditions. Medicare Plan C will protect you from out of pocket expenses and allow you the comfort of knowing your money is safe and where it belongs - in your pocket.