In order to make a good decision when choosing a Medicare supplement insurance plan you have to know all the facts. Rather than just give you a little information and hope for the best, we want to give you detailed information on each Medigap plan so you can really understand what's being compared. We'll look at the C plan now which has been traditionally one of the top 3-5 Medicare supplement plans in popularity over the years.
Let's break down the C Medigap plan piece by piece according to the main sections of traditional Medicare. This will not only tell us what the C plan covers but really get into the nuts and bolts of Medicare itself. It's always helpful to know the core of Medicare before deciding on a supplemental plan to work with it. We'll start with the important parts and how the C works in conjunction.
There are four main parts to address first which constitute 80% of what Medicare really covers (if not more). These are key items to look at when considering which Medigap plan to go with . The break down into 2 main categories and then 2 main parts of each category for a total 4 different components. First, there's the Part A section of traditional Medicare. Part A refers to Hospital based coverage and basically refers to facility based care. Part B on the other hand, refers to most services outside of the Part A facility section. This is generally thought of as physician charges although these days, diagnostic lab and x-ray make up a big part of this section. Those are two main categories of benefits but Medicare breaks them up into 2 main types of benefits which are pretty common to most people.
First, you have a deductible which you must pay first before you get help in the form of a percentage that Medicare pays. The Part A or hospital deductible is higher of course than the Part B deductible. Once the deductibles are met, you pay 20% of the charges indefinitely. This really is the core costs associated with Medicare or better yet, what Medicare does not cover. The Medicare supplemental plans cover these sections in various ways. What about the C plan? The C plan is very rich with these main holes in Medicare in that it covers both deductibles plus the 20% co-insurance for both hospital and physician charges. You should have very little if any out of pocket when using Medicare providers if you have the C plan. In fact the C plan is identical to the F plan (largely considered the best value among the Medigap plans) in these 4 areas. This is true for the other categories in that the C plan covers all the main categories except for one very important one which is Medicare Excess charges.
Excess refers to the ability of a provider to charge up to 15% higher than what Medicare allows and still remain a provider. This additional charge would then fall on you or a Medicare supplement if your particular plan covers it. The C plan does not cover it and this is the reason that most people look at the F plan when compared to the C plan and for good reason. That potential 15% does not have a ceiling. It can continue indefinitely if you have very large bills and the whole point of insurance is to provide some cap on total exposure. The C plan will not provide this cap as it relates to Excess charges.
All the other main categories are covered by the C plan. This includes Hospice care, Skilled Nursing Facility, the first 3 pints of blood, Foreign travel, and of course Preventative benefits. In fact, the only hole in the C plan is the Excess charge mentioned above. Typically, the cost difference between the C and F Medigap plans are not enough to warrant this potential risk and therefore, the F plan is generally chosen.