Summary

Medigap Plan C is a type of Medicare Supplement Insurance that helps pay certain out-of-pocket costs left over after Original Medicare (Parts A and B) pays its share. However, Plan C isn’t available to most people who became eligible for Medicare on or after January 1, 2020, because it covers the Part B deductible. If you’re looking for similar coverage and can’t buy Plan C, Medigap Plan D is often the closest alternative.

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🧩 How Medigap Plan C Works

Medigap plans work alongside Original Medicare. After Medicare pays its approved amount for covered services, your Medigap plan can help cover certain remaining costs, such as copayments, coinsurance and some deductibles. To enroll in any Medigap plan, you must have Medicare Part A and Part B. Medigap plans generally aren’t available if you’re enrolled in a Medicare Advantage plan.

Takeaways:

• Medigap Plan C helps pay certain costs left after Original Medicare pays, such as coinsurance, copays and some deductibles.

• You must be enrolled in Medicare Parts A and B to be eligible for a Medigap plan.

• Most new Medicare enrollees can’t buy Plan C because it covers the Part B deductible.

Key Terms

• Original Medicare: The federal health coverage program made up of Medicare Part A (hospital coverage) and Part B (medical coverage).

• Medigap: Medicare Supplement Insurance sold by private insurers to help cover certain out-of-pocket costs not paid by Original Medicare.

• Coinsurance: Your share of the cost for a covered service, typically a percentage of the Medicare-approved amount.

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🧾 What Medigap Plan C Covers

Medigap Plan C includes a broad set of benefits that help reduce common out-of-pocket expenses. This includes hospital-related costs under Part A, certain cost-sharing under Part B, and limited coverage for emergency care during foreign travel. One key reason Plan C is restricted for many new enrollees is that it covers the Medicare Part B deductible, which newer Medigap policies generally aren’t allowed to include for people newly eligible for Medicare after January 1, 2020.

Takeaways:

• Plan C helps cover Part A coinsurance and hospital costs (including extra hospital days after Medicare benefits are used up).

• Plan C covers the Part A deductible and hospice coinsurance/copays.

• Plan C covers Part B coinsurance/copays and (for eligible members) the Part B deductible.

• Plan C also covers skilled nursing facility coinsurance, the first three pints of blood, and limited foreign travel emergency care.

Key Terms

• Part A deductible: The amount you pay out of pocket before Medicare Part A starts covering hospital-related costs in a benefit period.

• Part B deductible: The annual amount you pay before Medicare Part B begins paying its share for covered services.

• Skilled nursing facility coinsurance: The daily amount you may owe for certain covered skilled nursing facility stays after Medicare pays part of the cost.

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🚫 What Medigap Plan C Doesn’t Cover

Even though Medigap Plan C offers strong coverage for many gaps in Original Medicare, it doesn’t cover everything. One notable difference between Plan C and some other Medigap options is that Plan C does not cover Medicare Part B excess charges, which can occur if a provider is allowed to bill more than the Medicare-approved amount and chooses to do so. Plan C also doesn’t include benefits that Medigap plans typically don’t provide at all, such as prescription drug coverage or routine dental and vision care.

Takeaways:

• Plan C doesn’t cover Medicare Part B excess charges.

• Plan C doesn’t include prescription drug coverage.

• Plan C doesn’t cover long-term care, routine dental care, routine vision care or private-duty nursing.

Key Terms

• Part B excess charges: Extra amounts a provider may charge above Medicare’s approved amount if they don’t accept Medicare assignment (where permitted).

• Prescription drug coverage: Coverage for outpatient medications, typically provided through Medicare Part D (not Medigap).

• Long-term care: Ongoing assistance with daily activities, such as bathing or eating, which is generally not covered by Medicare or Medigap.

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🔁 Medigap Plan C Alternatives

If you’re not eligible to buy Medigap Plan C, Medigap Plan D is often the closest alternative. Plan D covers nearly everything Plan C covers, except the Medicare Part B deductible. Because newer Medigap policies generally can’t be sold with Part B deductible coverage to people newly eligible for Medicare after January 1, 2020, Plan D is designed to offer similar protection while following the current rules. As you compare plans, it can help to focus on which costs you want to limit most—like deductibles, coinsurance, or potential excess charges—and weigh those benefits against the monthly premium.

Takeaways:

• Plan D is the most similar option to Plan C for people who can’t buy Plan C.

• The main difference is that Plan D does not cover the Part B deductible.

• Medigap plans are standardized in most states, but some states have different plan rules.

Key Terms

• Medigap Plan D: A Medicare Supplement plan with benefits similar to Plan C, but without coverage for the Part B deductible.

• Standardized plans: Medigap plans that must offer the same core benefits by letter (like Plan C or Plan D) in most states, regardless of the insurer.

• Premium: The monthly amount you pay to keep your Medigap policy active.

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🗓️ When to Enroll in a Medigap Plan

Your Medigap open enrollment period is usually the easiest and most affordable time to buy a Medicare Supplement plan. This one-time window begins when you’re 65 or older and enrolled in Medicare Part B, and it lasts for six months. During this period, insurers generally can’t use your health or medical history to raise your price or deny you coverage. Once the open enrollment period ends, you may pay more or you could be denied coverage depending on your health and state rules. Some states also offer Medigap options for people under 65 who qualify for Medicare due to disability.

Takeaways:

• Medigap open enrollment starts when you’re 65 and enrolled in Part B, and it lasts six months.

• During this time, insurers typically can’t charge more or deny coverage based on health history.

• After open enrollment, your options and pricing may depend on underwriting rules in your state.

Key Terms

• Medigap open enrollment period: A one-time six-month window when you can buy any Medigap policy sold in your state, usually without medical underwriting.

• Medical underwriting: A process insurers may use to review your health history to decide whether to accept your application and how much to charge.

• SHIP: State Health Insurance Assistance Program, a free resource that can help you understand Medicare and Medigap options in your state.

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Conclusion

Medigap Plan C can still be a valuable option for people who were eligible for Medicare before January 1, 2020 and can purchase it or already have it. For most newer Medicare enrollees, Plan C isn’t available because it covers the Part B deductible, but Plan D is often a close substitute with very similar benefits. If you’re comparing Medigap choices, paying attention to what’s covered, what isn’t, and when you’re allowed to enroll can help you find a plan that fits both your medical needs and your budget.