Lucky Mulay

Medicare Supplement Plan G, also called Medigap Plan G, is a supplemental policy that has become more common since it was first made available a few years ago. And thanks to the phasing out of the popular Medigap Plan F in 2022, Plan G is now the plan of choice for many.

There are 10 standardized Medicare Supplement policies (A, B, C, D, F, G, K, L, M, N) that help reduce your costs under Original Medicare (Part A and B). Medicare doesn’t fully cover all treatments and services, leaving “gaps” that these policies can fill.

If you have a Medigap policy, you can use any doctor, hospital or facility that accepts Medicare in the U.S. and U.S. territories such as Puerto Rico or the Virgin Islands. The healthcare providers must be enrolled in Medicare and must accept new Medicare patients. The majority of doctors and hospitals in the U.S. take Original Medicare.1 Six of the plans (C, D, F, G, M, N) cover foreign travel emergencies up to plan limits — typically $ 50,000-lifetime limit coverage after an initial $250 deductible in the first two months of travel .2

Plan F is considered the top-of-the-line Medigap policy. It covers 100% of the gaps in Medicare. Plan G’s coverage is nearly as good with one exception: Plan G does not cover the Part B deductible, which is $233 in 2022. Even with paying the Part B deductible, many Medicare enrollees find Plan G more cost-effective than Plan F when considering their respective premiums.

Plan G covers everything that Medicare Part A and B cover at 100% except for the Part B deductible. This means that you won’t pay anything out-of-pocket for covered services and treatments after you pay the deductible.

Like Medigap Plan F, Plan G also covers “excess charges.” Doctors who don’t accept the full Medicare-approved amount as full payment can charge you up to 15% more than the Medicare-approved amount for services or procedures. This is known as the “excess charge.”3 Most doctors accept the Medicare-approved payment and cannot bill you the extra amount. Since 2016, excess charges are illegal in these states: Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, and Vermont.

* You have 60 additional days to use beyond 90 days at the $742 daily rate. These are Lifetime Reserve days you can use across different Benefit Periods (each time you are in a hospital or skilled nursing facility). There must be at least 60 days between stays to use Lifetime Reserve days.

These amounts are applied to each “benefit period” which is when you enter a hospital or skilled nursing facility (SNF) and ends when you have not received care in those settings for 60 days in a row.

Medicare generally does not pay for Part A and B services or items outside the U.S. and U.S. territories. Medicare may, however, cover inpatient hospital care outside the U.S. under rare circumstances.

Medicare Part B mainly focuses on outpatient services. After you pay the initial Part B deductible, which is $233 in 2022, your coinsurance rate is 20%.

Part B services covered at 80% include outpatient care in an emergency room or hospital, and diagnostic tests such as X-rays. For many preventive services, the coinsurance and the deductible do not apply such as standard flu shots, mammograms, bone density tests, glaucoma tests, and many cancer screenings. Some preventive services have criteria you need to meet before getting the preventive service without the coinsurance and/or deductible. If you don’t meet the criteria, the service will be covered under Part B but with the coinsurance and deductible.

Part B also covers doctor’s visits, ambulances, mental healthcare, outpatient surgeries, home health care, durable medical equipment (DME) such as blood sugar monitors and test strips, lancet devices, walkers, and wheelchairs. Home health care is also covered under Medicare Part A if certain conditions are met.

Medicare Part B does not generally cover healthcare outside of the U.S. You may find this publication, “Medicare Coverage Outside the US,” helpful for specific examples of when Medicare covers healthcare outside the US.

If Original Medicare doesn’t cover something, no Medicare Supplement plan will cover it. Medicare does not cover:

Plan G premium costs vary widely, depending on where you live. In many states, costs also vary based on your gender and whether you smoke or vape.

In 2021, Plan G costs range from $99 per month to $476 per month.4 According to a price analysis conducted by the American Association for Medicare Supplement Insurance in February 2021:

If you qualify for Original Medicare, you may be able to enroll in Plan G. American citizens and legal residents of at least five years can qualify for Medicare. Having worked 10 or more years is a requirement for getting Part A without a premium. If you have not worked 10 years in the US, you may still be eligible for Medicare but you have to pay the Part A premium. And in most cases, you should either be turning 65 or have a disability that qualifies for Social Security disability benefits.

The only exception to getting Medicare without the 2-year wait is amyotrophic lateral sclerosis (ALS). Cancer and other diseases e.g. some cases of breast cancer, early-onset Alzheimer’s disease, may be considered a disability if it meets the SSDI criteria and the 24-month waiting period applies.5

The best time to enroll in Plan G is during the Medigap Open Enrollment Period (OEP). The OEP starts when you turn 65 and your Medicare Part B is effective. Medicare enrollees 65 years or older can buy a Medigap at any time but may be subject to health screening and medical underwriting. There are some advantages to buying a Medigap during one’s open enrollment period. During OEP, healthy people and those with health conditions will pay the same for Plan G from the same company.6

If you are under age 65 and have Medicare, you may be able to apply for a Medicare Supplement plan depending on where you live. Some states require Medigap insurance companies to sell Medigap plans to Medicare enrollees younger than 65. Each state has its own rules regarding health screening, rates, and Open Enrollment for Medicare enrollees younger than 65. For example, Open Enrollment is ongoing for under age 65 Medicare beneficiaries in some states which means you can start a new Medigap plan the first day of the following month. Please check with your state insurance department for specific guidelines.

In most states, if you sign up outside the OEP, you may be subject to medical underwriting. This means you could pay a higher premium if you have preexisting health conditions. Your application might even be declined. Only four states (Connecticut, Massachusetts, Maine and New York) require health insurance companies to offer Medigap policies to those who are eligible, whether or not they have preexisting conditions.7

If you currently have a Medicare Advantage plan and want to go with a Medigap policy, when can you switch to Plan G? You can switch to Original Medicare during the Annual Election Period from October 15 to December 7, or the Medicare Advantage OEP from January 1 to March 31. Then you can apply for a Medicare Supplement plan.

In most states you will not have guaranteed-issue rights when you switch, meaning you might face medical underwriting and higher premiums. Some states do allow it. To see what the Medigap rules are where you live, check with your state insurance department.

Plan G is the top-of-the-line Medigap option if you’re newly eligible for Medicare. Depending on where you live in the country, it can range from $99 per month to $476 per month for the plan premium, which is $1,188 to $5,712 per year. For the premium, which is higher than for other Medigap policies, you’ll get more comprehensive coverage.

Plan G covers nearly all out-of-pocket costs for services and treatment once you pay the Medicare Part B $233 deductible. This means you pay no copays or coinsurance.

If you don’t need that level of coverage, though, you might want a plan with less coverage.

There are nine other plans for beneficiaries to consider, but Plans F, G and N are the most popular.

Plan F has for many years had the highest number of enrollees, covering more than half of policyholders from 2014 to 2017. Plans C, G and N have been popular choices, with G and N gaining popularity for the same time period.8

In 2020, Medigap Plans C and F aren’t available to those newly eligible for Medicare.9 If you’re already a Medicare member, you can still choose Plan F or C.

Plan F and Plan N are often chosen instead of Plan G. Plan F is the most comprehensive Medigap plan since it covers 100% of the gaps in Medicare coverage, so costs more than Plan G or N. This means co-pays for Medicare-covered services and items under Medicare Part A or Part B will be $0 co-pay for those with Plan F. Plan G has nearly the same level of coverage as Plan F. With Plan G, you are responsible for the Part B deductible of $233. Otherwise, coverage is exactly the same as Plan F.

Plan N is the least expensive of these three plans but you’ll have more out-of-pocket costs with it. With Plan N you are responsible to pay these three items that Plan F covers in full:

If you’re more focused on preventive care like doctor’s visits, and don’t expect to have more serious medical needs, then Plan N could save you money.

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In genetics, complementary DNA (cDNA) is DNA synthesized from a single-stranded RNA (e.g., messenger RNA (mRNA) or microRNA (miRNA)) template in a reaction catalyzed by the enzyme reverse transcriptase.[1] cDNA is often used to express a specific protein in a cell that does not normally express that protein (i.e., heterologous expression), or to sequence or quantify mRNA molecules using DNA based methods (qPCR, RNA-seq). cDNA that codes for a specific protein can be transferred to a recipient cell for expression, often bacterial or yeast expression systems. cDNA is also generated to analyze transcriptomic profiles in bulk tissue, single cells, or single nuclei in assays such as microarrays, qPCR, and RNA-seq.

cDNA is also produced naturally by retroviruses (such as HIV-1, HIV-2, simian immunodeficiency virus, etc.) and then integrated into the host's genome, where it creates a provirus.[2]

The term cDNA is also used, typically in a bioinformatics context, to refer to an mRNA transcript's sequence, expressed as DNA bases (deoxy-GCAT) rather than RNA bases (GCAU).

RNA serves as a template for cDNA synthesis.[3] In cellular life, cDNA is generated by viruses and retrotransposons for integration of RNA into target genomic DNA. In molecular biology, RNA is purified from source material after genomic DNA, proteins and other cellular components are removed. cDNA is then synthesized through in vitro reverse transcription.[4]

RNA is transcribed from genomic DNA in host cells and is extracted by first lysing cells then purifying RNA utilizing widely-used methods such as phenol-chloroform, silica column, and bead-based RNA extraction methods.[5] Extraction methods vary depending on the source material. For example, extracting RNA from plant tissue requires additional reagents, such as polyvinylpyrrolidone (PVP), to remove phenolic compounds, carbohydrates, and other compounds that will otherwise render RNA unusable.[6] To remove DNA and proteins, enzymes such as DNase and Proteinase K are used for degradation.[7] Importantly, RNA integrity is maintained by inactivating RNases with chaotropic agents such as guanidinium isothiocyanate, sodium dodecyl sulphate (SDS), phenol or chloroform. Total RNA is then separated from other cellular components and precipitated with alcohol. Various commercial kits exist for simple and rapid RNA extractions for specific applications.[8] Additional bead-based methods can be used to isolate specific sub-types of RNA ......(e.g. mRNA and microRNA) based on size or unique RNA regions.[9][10]

Using a reverse transcriptase enzyme and purified RNA templates, one strand of cDNA is produced (first-strand cDNA synthesis). The M-MLV reverse transcriptase from the Moloney murine leukemia virus is commonly used due to its reduced RNase H activity suited for transcription of longer RNAs.[11] The AMV reverse transcriptase from the avian myeloblastosis virus may also be used for RNA templates with strong secondary structures (i.e. high melting temperature).[12] cDNA is commonly generated from mRNA for gene expression analyses such as RT-qPCR and RNA-seq.[13] mRNA is selectively reverse transcribed using oligo-dT primers that are the reverse complement of the poly-adenylated tail on the 3' end of all mRNA. An optimized mixture of oligo-dT and random hexamer primers increases the chance of obtaining full-length cDNA while reducing 5' or 3' bias.[14] Ribosomal RNA may also be depleted to enrich both mRNA and non-poly-adenylated transcripts such as some non-coding RNA.[15]

The result of first-strand syntheses, RNA-DNA hybrids, can be processed through multiple second-strand synthesis methods or processed directly in downstream assays.[16][17] An early method known as hairpin-primed synthesis relied on hairpin formation on the 3' end of the first-strand cDNA to prime second-strand synthesis. However, priming is random and hairpin hydrolysis leads to loss of information. The Gubler and Hoffman Procedure uses E. Coli RNase H to nick mRNA that is replaced with E. Coli DNA Polymerase I and sealed with E. Coli DNA Ligase. An optimization of this procedure relies on low RNase H activity of M-MLV to nick mRNA with remaining RNA later removed by adding RNase H after DNA Polymerase translation of the second-strand cDNA. This prevents lost sequence information at the 5' end of the mRNA.

Complementary DNA is often used in gene cloning or as gene probes or in the creation of a cDNA library. When scientists transfer a gene from one cell into another cell in order to express the new genetic material as a protein in the recipient cell, the cDNA will be added to the recipient (rather than the entire gene), because the DNA for an entire gene may include DNA that does not code for the protein or that interrupts the coding sequence of the protein (e.g., introns). Partial sequences of cDNAs are often obtained as expressed sequence tags.

With amplification of DNA sequences via polymerase chain reaction (PCR) now commonplace, one will typically conduct reverse transcription as an initial step, followed by PCR to obtain an exact sequence of cDNA for intra-cellular expression. This is achieved by designing sequence-specific DNA primers that hybridize to the 5' and 3' ends of a cDNA region coding for a protein. Once amplified, the sequence can be cut at each end with nucleases and inserted into one of many small circular DNA sequences known as expression vectors. Such vectors allow for self-replication, inside the cells, and potentially integration in the host DNA. They typically also contain a strong promoter to drive transcription of the target cDNA into mRNA, which is then translated into protein.

cDNA is also used to study gene expression via methods such as RNA-seq or RT-qPCR.[18][19][20] For sequencing, RNA must be fragmented due to sequencing platform size limitations. Additionally, second-strand synthesized cDNA must be ligated with adapters that allow cDNA fragments to be PCR amplified and bind to sequencing flow cells. Gene-specific analysis methods commonly use microarrays and RT-qPCR to quantify cDNA levels via fluorometric and other methods.

On 13 June 2013, the United States Supreme Court ruled in the case of Association for Molecular Pathology v. Myriad Genetics that while naturally occurring genes cannot be patented, cDNA is patent-eligible because it does not occur naturally.[21]

Some viruses also use cDNA to turn their viral RNA into mRNA (viral RNA → cDNA → mRNA). The mRNA is used to make viral proteins to take over the host cell.

An example of this first step from viral RNA to cDNA can be seen in the HIV cycle of infection. Here, the host cell membrane becomes attached to the virus’ lipid envelope which allows the viral capsid with two copies of viral genome RNA to enter the host. The cDNA copy is then made through reverse transcription of the viral RNA, a process facilitated by the chaperone CypA and a viral capsid associated reverse transcriptase.[22]

cDNA is also generated by retrotransposons in eukaryotic genomes. Retrotransposons are mobile genetic elements that move themselves within, and sometimes between, genomes via RNA intermediates. This mechanism is shared with viruses with the exclusion of the generation of infectious particles.[23][24]

Mark D. Adams et al. “Complementary DNA Sequencing: Expressed Sequence Tags and Human Genome Project.” Science (American Association for the Advancement of Science) 252.5013 (1991): 1651–1656. Web.

Philip M. Murphy, and H. Lee Tiffany. “Cloning of Complementary DNA Encoding a Functional Human Interleukin-8 Receptor.” Science (American Association for the Advancement of Science) 253.5025 (1991): 1280–1283. Web.