Medicare Part C has not been discontinued. However, Medigap Plan C is no longer available to new Medicare enrollees from January 1, 2020.
Medicare is a federal insurance plan for people aged 65 and older. It pays for many healthcare services. On the other hand, Medigap is offered by private companies and it is Medicare supplement insurance designed to fill the gaps in original Medicare.
In this article, we look at both Medicare and Medigap, and the differences between them. We also discuss Medicare Part C and Medigap Plan C. We also examine eligibility, enrollment and costs.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Because there is a Medicare Part C and a Medigap Plan C, the two different policies may be confused. Here is a guide to the basic differences between them:
- Medicare is a government health insurance program, which includes Part A, Part B, and Part D. It is generally available to a person who is 65 years old, or to a person with end stage renal disease, or sometimes to younger people with certain disabilities.
- Medicare Advantage (Part C) plans are alternatives to original Medicare. They combine the benefits of Medicare parts A and B, and can also provide prescription drug coverage. A person with this type of private insurance plan pays a premium, copays, and a deductible.
- Medicare insurance supplement plans (Medigap) can only be used with original Medicare. The 10 plans, including Plan C, are designed to helps fill the gaps in original Medicare’s coverage including coinsurance, copays, and deductibles.
A person cannot use a Medicare supplement plan with a Medicare Advantage Plan. Medigap helps pay the out-of-pocket costs of Medicare parts A and B. It is not allowed to help cover costs from Medicare Advantage.
Medicare Advantage plans are sometimes called Part C and are designed to be an alternative to original Medicare. They are offered by private companies.
The plans include the same coverage as offered by original Medicare, and may also include a drug prescription (Medicare Part D) plan. All plans must follow Medicare rules.
Medicare Part D is the prescription drug benefit. This is also sold by a private company. However, Advantage plans do not offer prescription benefits, and a person may choose to enroll in Medicare Part D.
Medicare pays Advantage a fixed amount every month to cover a person’s healthcare costs. While they must offer the same benefits as Medicare parts A and B, they can charge different out-of-pocket costs.
Medicare Advantage plans can also set different rules on how a person gets services. For example, some Advantage plans require a referral to see a specialist and others do not.
Medicare supplement insurance, also called Medigap, has 10 plans, identified by letters: A, B, C, D, F, G, K, L, M, and N.
From January 1, 2020, no Medigap policy is allowed to pay the Part B deductible, which means Medigap Plan C cannot be offered to new enrollees in Medicare. However, a person previously enrolled in Plan C can keep the policy.
Medigap Plan C helps pay for the following costs:
- Part A deductible
- Part A coinsurance and hospital costs
- Part A coinsurance or copayment for hospice
- Part A coinsurance for skilled nursing facility care
- Part B deductible
- Part B coinsurance or copayment
- blood, first 3 pints
- foreign travel exchange, up to 80%
However, there are two benefits Plan C does not cover, including the Part B excess charge and the out-of-pocket limit.
Because Medicare Part C and Medigap Plan C are different, eligibility is also different.
Medigap Plan C
People new to Medicare are not eligible for Medigap Plan C. However, if a person enrolled in Plan C before 1 January 2020, they can keep the plan. In addition, a person who was eligible to be enrolled in Medicare before that date could also enroll in Plan C.
Medicare Advantage (Part C)
A person can enroll in Medicare Advantage (Part C) if they have Medicare parts A and B, live in an area where the plan is offered, and are a United States citizen.
In addition, a person with end stage renal disease can also enroll, as may younger people with certain conditions.
Private companies can choose where they offer Advantage plans. Not every company will offer an Advantage plan in every state. A person can use this online tool to find plans in their area.
Options and coverage
Medicare Advantage plans have various options, including the following.
- Health Maintenance Organization (HMO) plans
- Preferred Provider Organization (PPO) plans
- Private Fee-for-Service (PFFS) plans
- Special Needs plans (SNPs)
- Medical Savings Account (MSA) plans
There are various periods when a person can enroll in an Advantage plan or in a Medigap plan.
Initial enrollment
A person who is new to Medicare can enroll in an Advantage plan or join a Medigap plan during the time they first become eligible, which is 3 months before their birthday month when they turn 65 year old, the month of their birthday, and 3 months after that month.
In addition, a person may enroll during this period because they have a disability, or because they have Medicare Part A and enrolled in Part B during the General Enrollment Period.
Open enrollment
A person can join a Medigap plan during this period, and the company offering the plan has to accept a person to the plan regardless of any health conditions. At other times, enrollment may carry . This online tool may help a person find a Medigap plan.
A company offering an Advantage plan may choose to leave the Medicare program, and a person will automatically be switched back to original Medicare, and can then choose to enroll in a different Advantage plan during the Open Enrollment Period.
From October 15 to December 7 every year, a person can drop their Advantage plan, or they can take any of the following actions:
- change from original Medicare to a Medicare Advantage plan
- change from a Medicare Advantage Plan back to original Medicare
- switch between Advantage plans
- switch to an Advantage Plan that offers drug coverage
- switch to an Advantage Plan that doesn’t offer drug coverage
- join Medicare Part D
- switch from one drug plan to another
A person can use this online tool to find plans in their area.
Medicare Advantage open enrollment
From January 1 to March 31 each year a person can switch Advantage plans or go back to original Medicare.
After choosing a plan, a person can enroll in an Advantage plan through the company’s online process or by asking for a paper enrollment form. The company will ask for a person’s Medicare number and the date coverage started.
Under Medicare’s rules, Advantage plans must offer at least the same benefits as Medicare parts A and B. How the benefits are offered can be done differently by the private companies. The companies may also offer more benefits in their Advantage plans.
Costs vary between Advantage plans, and a person’s out-of-pocket expenses will also depend on their particular policy how often they use their Advantage plan. A person may want to check with their plan provider. They can also get more information from the notices sent to them by Medicare, including Evidence of Coverage and the Annual Notice of Change.
Medigap policies also have varied costs. A person can check costs, including premiums, with the company that holds their policy.
Medicare Part C is also called Medicare Advantage. This has not been discontinued.
Medigap Plan C has been discontinued for new enrollees to Medicare. Medigap is another name for a Medicare Supplemental Insurance option to help pay gaps in Medicare parts A and B.
There are 10 Medigap policies, although Medigap Plan C has been discontinued for a person who is enrolling in Medicare after January 2020.