First dollar coverage

In 2014, Congress passed legislation – Medicare Access and CHIP Reauthorization Act of 2015 – that included a prohibition against “first-dollar” Medigap coverage (i.e. Plan F). This took effect in 2020. The idea was to reduce over spending by beneficiaries who had little reason to care about out-of-pocket costs.

In 2022 Medicare for All proposals include elimination of all deductibles, co-payments and co-insurance, effectively eliminating all out-of-pocket costs at the point of service.

So which is it? Should patients have a reason to care about their health care (over) spending or not?


  1. I’ve had Plan F for almost 20 years and the fact that I have no deductible has never entered my mind when I was debating (with myself) whether to go see a doctor or not.

    Liked by 1 person

  2. I think in the end it will not matter other than costing us taxpayers more. Cost is only a factor for those who do not have the money. They will delay treatment. Others will not be able to find the time until more expensive treatment is needed. A third group will be the over users who need a doctor’s note for work or subject to child custody disputes. Hypochondriacs don’t care either way.
    The other issue I see is if I have no skin in the game as to cost, who do I see? Sometimes it is a guess if I wait to see my primary care doctor, go to urgent care, or the emergency department? If their are no limits then do I just go to a specialist and clog their calendar too?
    Also, what I think needs to happen first is the perfection of electronic records so that your records follow you from provider to provider in real time. This way treatment will coordinated instead of being “shopped”.

    Liked by 1 person

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s