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Understanding Medigap Plan C

Understanding Medigap Plan C

Understanding Medigap Plan C can help you to cover some out-of-pocket health care expenses that you may be paying each year unnecessarily. Even though Medicare was initially set up to help in paying for health care costs for those who are 65 years old and over – as well as certain other individuals who are disabled – the program leaves a lot of “gaps” in its coverage.

These can come in the form of copayments, coinsurance, and / or deductibles such as with a Medicare supplement Plan N. Over the course of just one year, depending on how often you visit your doctor or need certain treatment, you could be paying out thousands of dollars. But, by having a Medicare Supplement insurance plan, the coverage can help you to greatly reduce these annual costs. If you already have a plan such as Plan J and have questions, we can find the answers you are looking for.

What is Covered Under Medicare Supplement Insurance Plan C?

All insurance carriers that offer Medicare Supplement insurance must provide the same coverage for plans of the same corresponding letter. This means that a Medicare Supplement Plan A that is offered by one insurer will have the same identical coverage as a Plan A that is offered by any other insurer.

But, while the benefits must be the same, the premium price that is charged can differ – sometimes quite a bit – from one insurer to another. For this reason, it is important to shop around before purchasing a Medicare Supplement insurance plan.

Although Medicare Supplement Plan A offers a basic set of benefits, there are other Medigap plans that provide more comprehensive coverage – which can, in turn, provide you with additional savings. This can be especially beneficial for those who may visit their doctor more regularly throughout the year and / or require more medical treatment.

Medicare Supplement Plan C, can offer much more comprehensive coverage over most of the other medigap plans as it provides the following benefits (in 2016):

  • Medicare Part A coinsurance for hospitalization costs – up to an additional 365 days after Medicare benefits are used up;
  • Medicare Part B copayment or coinsurance coverage;
  • First three pints of blood per year;
  • Medicare Part A hospice care coinsurance or copayment;
  • Skilled nursing facility care coinsurance;
  • Medicare Part A deductible;
  • Medicare Part B deductible;
  • Foreign Travel Emergency (80%).

The only gap in Medicare that is not covered is excess charges for Medicare Part B.  This means that if your physician were to charge more than the recommended amount for any outpatient care you would be responsible for the difference.  Medicare supplement Plan F is the only plan to cover all the gaps and Medigap Plan G covers the excess charges gap but does not cover the Part B deductible.

Why Consider Medicare Supplement Plan C Over Other Medigap Plans?

While some Medicare enrollees may wish to keep premiums low, others may wish to consider Medicare Supplement Plan C for the additional benefits that it provides. Because it offers coverage for both Medicare Part A and Part B’s deductibles, it can provide a substantial savings as soon as an enrollee uses their Part A and / or Part B coverage.

Plan C of Medigap also offers the added benefit of Foreign Travel Emergency coverage. So, for someone who tends to travel outside of the United States – even on a limited basis – this can provide additional peace of mind.

How Medicare and Its Expenses Work

While Medicare was initially set up as just two parts, today the program consists of four different components. These include the following:

  • Part A – Hospital Coverage: Medicare Part A provides hospital coverage, which can include care that is received as an inpatient, as well as some types of home health care that follows an inpatient hospital stay. In addition, Medicare Part A may also cover some hospice services.
  • Part B – Medical / Doctors’ Services: Medicare Part B offers coverage for medical / doctors’ services, which may help you to cover items such as outpatient hospital care, visits to your doctor, and emergency department care, as well as certain equipment that may be required in your home. Medicare Part B can also provide coverage for certain types of preventive care such as the vaccinations for pneumonia and the flu. Medicare Part A and Part B are referred to as “Original Medicare.”
  • Part C – Medicare Advantage: Medicare Part C is also referred to as Medicare Advantage. This is an alternative way of receiving your Part A and Part B Medicare benefits. It can often take on a “managed care” approach like an HMO (Health Maintenance Organization) or PPO (Preferred Provider Organization). If you are eligible for Medicare Part A and Part B, you can choose to receive your services via Medicare Part C. If you do so, you can obtain a Part C plan through a private insurer. Part C plans must offer all of the same benefits that Part A and B of Medicare provide – plus they can offer additional benefits, such as dental, vision, and / or wellness. If you have a Medicare Advantage plan, you may also have prescription drug coverage included in your plan.
  • Part D – Prescription Drug Coverage: Part D of Medicare provides coverage for prescription drugs. These plans are also sold via private insurance companies – so the premiums and the actual benefits can differ from one insurer to another. If you have Medicare Part A and Part B (Original Medicare), and you also wish to have prescription drug coverage, then you will need to purchase a separate Medicare Part D plan.

Although Medicare Part A and Part B will cover a wide array of services, they also come with a fair amount of out-of-pocket expenses to the enrollee. For example, each of these Medicare parts has a deductible that must be paid before coverage taking over. In 2016, these include the following:

Medicare Part A hospital inpatient deductible and coinsurance: • $1,288 deductible for each benefit period

  • Days 1 – 60: $0 coinsurance for each benefit period
  • Days 61 – 90: $322 coinsurance per day of each benefit period
  • Days 91 and beyond: $644 coinsurance per each “lifetime reserve day” after day 90 for each benefit period (up to 60 days over your lifetime)
  • Beyond lifetime reserve days: all costs

Medicare Part B deductible and coinsurance:

  • Deductible of $166
  • After the deductible is met, you typically pay 20% of the Medicare-approved amount for most doctor’s services (including most doctor’s services while you are a hospital inpatient), outpatient therapy, and durable medical equipment.

What is Medicare Supplement Insurance?

Because there are so many potential out-of-pocket expenses, the costs can truly add up. These can, however, be reduced – or even eliminated in some cases – through a Medicare Supplement insurance plan.

Medicare Supplement insurance is designed to fill in the “gaps” in Medicare Part A and Part B coverage. For that reason, Medicare Supplement insurance is often referred to as “Medigap” insurance.

How Does Medicare Supplement Insurance (Medigap) Work?

Today, there are ten standardized Medicare Supplement, or Medigap, insurance plans. These plans are all named after a letter of the alphabet, starting with Medicare Supplement Plan A. This plan provides the most basic set of “core” benefits – and most of the other Medigap plans are required to offer at least these core coverages.

What to Consider When Choosing a Medicare Supplement Insurance Plan

Before you enroll in any Medicare Supplement insurance plan, it is good idea to consider certain factors. This is because you will want to ensure that you will be getting the very best plan for you and your specific needs.

With that in mind, the following criteria can be helpful when choosing your Medigap plan:

  • What are your specific health care needs throughout the year, as well as the services that are most important to you, and to your spouse (if applicable);
  • How much can you comfortably afford to pay in Medicare Supplement insurance premiums as versus in out-of-pocket Medicare Part A and B expenses.

It is also important to take a look at the financial stability and claims paying reputation of the insurance company that you are considering purchasing the coverage through. This can help you in determining if the company in highly regarded in the industry.

Who is Eligible to Purchase Medicare Supplement Insurance?

Even if you are age 65 (or over) and receiving Medicare benefits, it is not always automatic that an individual is eligible to apply for Medicare Supplement insurance coverage. In fact, in order to be eligible, there are certain criteria that must be met.

First, you must be enrolled in Original Medicare (Medicare Part A and B), and not in Medicare Advantage (Part C). This is because those who are in a Medicare Advantage plan may already be getting some similar coverage.

When is the Best Time to Purchase a Medicare Supplement Insurance Policy?

The best time for you to enroll in Medicare Supplement is during your open enrollment period. This consists of the six-month period of time in which you turn age 65 and you are also enrolled in Medicare Part B. The reason for this is because, during your Medicare Supplement open enrollment period, you cannot be turned down for a policy – even if you have certain health issues.

However, if you wait too long and apply after the open enrollment period has expired, you run the risk of being charged a higher rate for your Medicare Supplement plan, or even being turned down for a plan altogether.

In many cases, it makes sense to apply for a Medicare Supplement insurance plan during open enrollment. If you wait until after this period has expired, you may still qualify for coverage with a pre-existing condition. The coverage for a pre-existing condition may only be excluded if it was diagnosed and / or treated within six months before the start of the coverage under the Medigap plan. After the six-month period has expired, the Medicare Supplement insurance plan will then cover the condition.

If, however, your health deems you uninsurable and you are not able to qualify at all for a Medicare Supplement insurance plan, you could end up without this type of coverage. In this case, it makes sense to apply during your open enrollment time period.

Where Can You Get the Best Premiums on Medicare Supplement Plan C?

When you are shopping for the best quotes on Medigap Plan C, it is always a good idea to shop and compare several different insurance company’s policies. This can help you to see the differences in premiums among the insurers, and to then determine which plan will be the best for you.

Understanding Medigap Plan C, as well as all of the benefits that can be covered with this policy, can help you to budget when you are considering which of the plans and policies most beneficial.

Working with a company or an agency that has access to more than just one insurance carrier can be helpful when you are comparing Medicare Supplement plans. This is because you will be able to quickly and conveniently compare plans in an unbiased manner.

If you are ready to move forward, we can help. We work with many of the top Medigap carriers in the industry, and we can assist you in obtaining all of the information that you need concerning Medicare Supplement Plan C and its premium quotes. In order to proceed, just simply fill out the form on this page.

We understand that choosing a Medicare Supplement plan can seem a bit overwhelming. There are a lot of details to go through, and you want to be sure that you are picking the very best policy for your specific needs. We are experts in this area and can walk you through all of the details. So, contact us today – we’re here to help.

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