Is Medigap Plan C gone?
This change was made to discourage people from visiting a doctorâ€™s office or hospital when it wasnâ€™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.
What if I already have a Medigap Plan C or want to sign up for one?
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.
Are there other similar plan options available?
Plan C wonâ€™t be available to you if youâ€™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 isnâ€™t covered by Plan C is whatâ€™s known as the Part B â€œexcess charges.â€ Excess charges are an amount above the Medicare- approved cost billed by a healthcare provider for a service. Excess charges arenâ€™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 canâ€™t enroll in either of those because you werenâ€™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 isnâ€™t covered, and youâ€™ll be responsible for some copayments. Under Plan N, youâ€™ll pay up to $20 for some office visits and up to $50 for emergency room (ER) visits that donâ€™t result in hospital admission.
The following chart compares the details of each of these plans more closely:
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:
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.
How do I choose the right plan for me?
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 donâ€™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 donâ€™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.
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.
Medicare plan options and costs are subject to change each year.
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