Medigap Plan C Benefits
Medicare Supplement Plan C, also known as Medigap Plan C, offers almost the exact same benefits a Medigap Plan F. The only difference is, it doesn’t cover Medicare Excess charges.
Medicare Excess charges are surcharges that your doctor can charge above and beyond what Medicare typically reimburses. Although, these charges are limited to 15% beyond what Medicare will pay, in some cases they charges can be a significant amount.
Most doctors do not charge excess charges, but some specialized doctors or facilities may. If something like this concerns you, a Medigap Plan F or G might be a better option, because these plans cover excess charges.
Consider this example . . .
Mary purchases a Medigap Plan C. Most of her doctors are participating Medicare doctors so Mary usually owes absolutely nothing. Mary twists her ankle while watering her plants. Then she notices swelling, so she visits an urgent care clinic for an X-ray. Unfortunately, the clinic does not accept Medicare assignment rates, so they end up billing Mary for excess charges. The normal fee for the X-ray is $75, but at this clinic there is a 15% excess charge, bringing the cost to $86.25. Since Mary’s Medigap Plan C does not cover excess charges, Mary will end up paying the difference of $11.25 to the urgent care facility.
As you can see, Medigap Plan C does offer more comprehensive coverage than Medigap Plan A or Plan B.
But, it still doesn’t cover everything . . .
What benefits does Medigap Plan C cover?
- 100% of the Medicare Part A hospital deductible - which is $1340 per each 60-day benefit period.
- 100% of all Medicare Part A coinsurance and hospital costs - which is the copays for days 61-90 ($335/day) and days 91-150 ($670/day) in hospital; also provides payment in full for 365 additional lifetime days.
- Skilled nursing facility care coinsurance - which is $167.50/day from days 21-100 in a skilled nursing facility per each benefit period.
- 100% of the Part B Coinsurance - which is the 20% coinsurance for Part B services, such as doctor’s services, laboratory and x-rays, durable medical equipment. Also covers coinsurance for hospital outpatient services.
- 100% of the cost of the first 3 pints of blood.
- 100% of the Medicare Part A hospice care coinsurance for respite care and other Part A-covered services.
What benefits doesn’t Medigap Plan C cover?
- Medicare Part B excess/limiting charges which can be 15% more than Medicare’s approved charge when a provider does not take assignment.
Medigap Plan C is NOT the same as Medicare Part C
So, here’s the big difference . . .
Medicare Part C, also known as Medicare Advantage Plans, are a replacement for Traditional Medicare Parts A, B, and D.
These plans are typically HMO, PPO, or PFFS type plans and are managed by private insurance carriers.
Additionally, these plans typically may have network restrictions along copays, coinsurance, and deductibles up to $6700/year.
Medigap Plan C is one of 11 different Medicare Supplemental plans available and are “standardized” by the federal government.
When you enroll in a Medigap Plan C you will enjoy the freedom of choice and peace of mind knowing that your health care costs will be covered, as long as, the doctor and of facility accepts Traditional Medicare.
So, if you’re like most people when it comes to choosing a Medicare Supplement, you may feel like your “spinning-your-wheels” just trying to figure it all out.
If so, you’re not alone . . .
Fortunately, the Medicare insurance specialists at New Jersey Medicare Plan can help - just give us a call at 1 (844) 280 -0785 and we’ll do the heavy lifting for you!
|Medicare Supplement Insurance Plans (Medigap)|
|Part A coinsurance and
hospital costs (up to an
additiona 365 days after
Medicare benefits are used)
|Part B coinsurance or
|Blood (first 3 pints)||100%||100%||100%||100%||100%||100%||50%||75%||100%||100%|
|Part A hospice care
coinsurance or copayment
|Skilled nursing facility care
|Part A deductible||100%||100%||100%||100%||100%||50%||75%||50%||100%|
|Part B deductible||100%||100%|
|Part B excess charges||100%||100%|
|Foreign travel emergency
(up to plan limits)
* Plan F is also offered as a high-
dedutible plan by some issuers in
some states. If you choose this
option, this means you must pay for
Medicare-covered costs (coinsurance,
copayments, deductibles) up to the
deductible amount of $2240 in 2018
before your policy pays anything.
** Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don't result in an inpatient admission.
*** For Plans K and L, after you meet your out-of-pocket yearly limits and your yearly Part B deductible ($183 for 2018), the Medigap plan pays 100% of covered services for the rest of the calendar year.