Medicare Plan C is a Medigap policy that covers costs Medicare Part B doesn't pay

Medicare Plan C (also called Medigap Plan C) is supplemental insurance sold by private companies. It pays some of the costs that Original Medicare leaves you responsible for — copayments, coinsurance, and deductibles. Plan C is no longer sold to people newly may be able to access for Medicare as of January 1, 2020, but people who had it before that date can keep it.

If you have Plan C now, it covers your Part B deductible (the amount you pay before Medicare starts paying), 80% of approved charges for certain outpatient services, and some skilled nursing facility costs. The exact coverage depends on which insurance company sells you the policy and what state you live in, because Medigap rules vary by state.

Plan C premiums are typically lower than Plan G (the plan that replaced it for new enrollees), but Plan G now covers the Part B deductible while Plan C does not. If you're considering switching plans or are new to Medicare, understanding what Plan C covers and what it doesn't will help you compare your real costs.

Key Takeaways

  • Plan C covers your Part B deductible and coinsurance for hospital and medical services, but you pay a monthly premium to the insurance company.
  • Plan C is closed to new Medicare enrollees as of 2020, though existing holders can renew it.
  • Plan G replaced Plan C for new enrollees and now covers the Part B deductible, which Plan C does not.
  • Your actual out-of-pocket costs depend on which insurance company you buy from and what state you live in, so comparing quotes is necessary.

What Plan C covers

Plan C covers your Part B deductible — the $240 amount (in 2024) you must pay out of pocket before Medicare Part B starts paying for doctor visits and outpatient services. It also covers 80% of the coinsurance you would normally owe after Medicare pays its 80% for things like lab work, X-rays, and doctor office visits.

The plan also covers some costs related to skilled nursing facility stays. After Medicare covers the first 100 days, you would normally pay the full cost of any additional days; Plan C covers coinsurance for days 101 through 150. Plan C does not cover prescription drugs — you need a separate Part D plan for that.

Plan C does not cover services Medicare itself doesn't cover, such as routine dental care, hearing aids, or vision exams. It also does not cover long-term care or custodial care in a nursing home. The plan covers only what Original Medicare covers; it fills in the gaps Medicare leaves, not gaps in what Medicare considers medically necessary.

How Plan C differs from Plan G

Plan G is the newer plan that replaced Plan C for people who became may be able to access for Medicare on or after January 1, 2020. The main difference is that Plan G covers your Part B deductible, while Plan C does not. This means Plan G enrollees pay the $240 deductible once per year, then Plan G covers coinsurance after that.

Plan C enrollees pay the Part B deductible themselves, then the plan covers coinsurance. Because the Part B deductible increases most years, Plan C's coverage gap has grown. For someone with many doctor visits, Plan G may cost less overall even if its monthly premium is higher, because you avoid paying the deductible.

Both plans cover the same skilled nursing facility coinsurance and other hospital-related costs. The choice between them depends on your expected doctor visits and the actual premiums your state's insurance companies are quoting — there is no single "better" plan without knowing those numbers.

How to use Plan C when you see a doctor

When you see a doctor who accepts Medicare, you show your Plan C card along with your Medicare card. The doctor's office bills Medicare first. Medicare pays its 80% of the approved amount. Your Plan C insurance then pays the coinsurance (the remaining 20%) directly to the provider or to you, depending on how the claim is processed.

You do not pay anything at the time of the visit in most cases, because the provider knows Plan C will cover the coinsurance. However, some providers bill you first and you submit the claim to your Medigap insurer for reimbursement. Ask the doctor's office which method they use before your appointment.

For the Part B deductible, you pay it yourself the first time you see a doctor or have an outpatient service in the calendar year. After you meet the deductible, Plan C covers coinsurance for the rest of that year.

Plan C premiums and how they change

Plan C premiums vary by insurance company and by state. In some states, the same plan costs $150 per month with one company and $200 with another. You must contact insurance companies directly or use your state's health insurance counselor to compare quotes — there is no single price.

Premiums typically increase each year. Some companies use community rating, meaning everyone in your state pays the same premium regardless of age. Others use age-rated pricing, where your premium increases as you get older. A few use issue-age rating, where your premium is based on your age when you first buy the plan and increases with inflation, not with your age.

You can switch to a different Medigap plan or a different insurance company, but rules about when you can switch and whether you must answer health questions depend on your state and your situation. If you have had Plan C for years and want to switch to Plan G, contact your state's health insurance counselor before making the change, because switching may trigger medical underwriting in some states.

When to contact your doctor or insurance company

Contact your Medigap insurance company if a claim was denied or if you received a bill you believe the plan should have covered. Keep copies of your Explanation of Benefits (EOB) from Medicare and any bills from providers — these documents show what Medicare paid and what you owe.

Contact your doctor's office if you receive a bill for coinsurance that seems wrong. Ask them to resubmit the claim to your Medigap insurer if it was not submitted the first time. If your Medigap company denies a claim, you have the right to appeal; your insurance company's customer service line can explain the appeal process.

If you are thinking about switching from Plan C to Plan G or another plan, contact your state's State Health Insurance information Program (SHIP) counselor before you make the change. SHIP counselors are free and can explain what switching will cost you and whether you will face medical underwriting.

Finding Plan C quotes and enrollment information

Because Plan C is closed to new enrollees, you can only buy it if you were already enrolled in Medicare before January 1, 2020. If you meet that requirement, contact insurance companies in your state directly to ask whether they still sell Plan C. Some companies have stopped offering it, while others continue to sell it to existing customers.

Your state's health insurance counselor can tell you which companies in your area still sell Plan C and can help you understand the quotes they provide. You can find your state's SHIP program by calling 1-800-MEDICARE or visiting the Medicare website.

If you are newly may be able to access for Medicare, Plan C is not an option. You can choose Plan G, Plan N, or another Medigap plan, or you can choose Medicare Advantage instead of Original Medicare plus Medigap. A SHIP counselor can walk you through the differences and help you compare costs based on your own doctors and prescriptions.

Frequently Asked Questions

Can I switch from Plan C to Plan G?

Yes, but the process and costs depend on your state and how long you have had Plan C. In some states you can switch without answering health questions; in others, the new company may require medical underwriting. Contact your state's SHIP counselor before switching to understand what will happen in your situation.

Does Plan C cover prescription drugs?

No. Plan C covers only hospital and medical costs. You need a separate Medicare Part D prescription drug plan. You can enroll in Part D when you first become may be able to access for Medicare, or during the annual open enrollment period in October and November.

What happens to my Plan C if I move to a different state?

Your Plan C coverage ends when you move. You must enroll in a new Medigap plan in your new state. Some insurance companies operate in multiple states, but your plan and premium will change. Contact your current insurer to find out what options are available in your new state.

Is Plan C the same in every state?

The benefits are standardized — all Plan C policies cover the same things. However, premiums vary widely by state and by insurance company. Your out-of-pocket costs depend entirely on which company you buy from and what state you live in.

What if I can't afford the Plan C premium?

Some people with low income and limited resources may be able to get help paying Medigap premiums through their state's Medicaid program. Contact your state Medicaid office or your SHIP counselor to learn whether you may have access to. You can also compare quotes from different companies, as premiums vary significantly.