This flow chart provides a high-level picture of the ways that people will obtain health coverage in 2014, assuming the Patient Protection and Affordable Care Act (ACA) is implemented as it exists today. It is intended as an overview of the pathways to coverage: while individuals may follow the flow chart and determine possible options, it is not intended to be comprehensive for that purpose. Rather, it is offered as a way to look ahead and better understand the many pathways to coverage that will exist in 2014, assuming the ACA is implemented under current law.

1. START The Path to Health Care Coverage Under the Affordable Care Act, in 2014
Are you age 65 or older?
YES
(Or otherwise entitled Eligible for
to Medicare, e.g. receive Medicare
This flow chart provides a high-level picture of the ways SSDI.)
that people will obtain health coverage in 2014, assuming
the Patient Protection and Affordable Care Act (ACA) is NO
implemented as it exists today. It is intended as an overview
of the pathways to coverage: while individuals may follow the Ineligible for Medicaid
NO CHILDREN 0 – 182 Coverage available
NO Family income less
NO but meet CHIP standard
NO
flow chart and determine possible options, it is not intended Are you age 19 – 64?
through parents? than139% FPL? (in Michigan, equal to or
to be comprehensive for that purpose. Rather, it is offered
less than 200% of FPL)?
as a way to look ahead and better understand the many
pathways to coverage that will exist in 2014, assuming the
YES NO YES YES
ACA is implemented under current law.
Uninsured
Exemptions from Individual Mandate1 YES Is available premium >8% (Penalty)
Do you choose to of income, or are you YES Eligible for
• Exempt from filing income tax Eligible for CHIP
remain uninsured? otherwise exempt from Medicaid4
• Incarcerated individual mandate? Uninsured
• Member of an Indian tribe (No Penalty)
• Those with short coverage gaps and hardships NO YES
• Member of religious sect exempted from paying Social
Security, Medicare, payroll, and self-employment taxes YES Choose YES
Are you less than 26 Covered under
• Lack access to affordable coverage (as defined in ACA option to be on parent’s
years old?
policy? parent’s policy
Sect. 1302)
• Undocumented immigrants
NO NO
Guide to Acronyms
CHIP — hildren’s Health Insurance Program
C YES YES
Choose option
FPL — Federal poverty level Are you less than 30 Buy catastrophic-only
to buy catastrophic-only
years old? insurance
SSDI — Social Security Disability Income insurance? 5
NO
1
Option to buy catastrophic-only coverage is available for individuals who
are exempt from the individual mandate due to hardship or lack of access
to affordable coverage. NO
2
Child-only plans are available for those under age 21 Is health coverage NO NO Is available premium on NO NO
Income less than139% the individual market Income equal to or less
available to you through
3
Employers with over 200 full-time employees must auto-enroll employees FPL? more than 8% of your than 400% of FPL?
in coverage. Employees may opt out to obtain coverage elsewhere or an employer?3
income?
remain uninsured (with possible penalty).
4
Legal immigrants in U.S. 5 years with incomes 139% of FPL are not
eligible for Medicaid but qualify for tax credits for buying coverage YES YES YES YES
through Exchange.
5
Eligible individuals can buy catastrophic-only insurance through the
Exchange, but premium tax credits cannot be used to buy this coverage. Choose option to
buy catastrophic-only NO
6
Premium tax credits can be used to buy single or family plans on the
insurance?5
individual market of the Exchange.
YES
The Center for Healthcare Research Transformation (CHRT)
illuminates best practices and opportunities for improving health
Buy coverage on
policy and practice. Based at the University of Michigan, CHRT is Buy coverage on
a non-profit partnership between U-M and Blue Cross Blue Shield Exchange and receive
Exchange
of Michigan designed to promote evidence-based care delivery, premium tax credits
improve population health, and expand access to care. Eligible for Buy catastrophic- or individual
(and cost-sharing
Medicaid4 only insurance market without
subsidies if income
premium tax
equal to or less than
credits
250% FPL)6
© Center for Healthcare Research Transformation, December 2011
www.chrt.org/ACAflowchart Page 1 of 2

2. YES
NO Is available premium NO Is available premium NO Is available premium
Income less than 139%
equal to or less than 8% between 8% and 9.5% of more than 9.5% of your
FPL?
of your income? your income? income?
YES YES YES YES
NO NO NO
Income equal to or less Income equal to or less Income equal to or less
than 400% FPL? than 400% FPL? than 400% FPL?
YES YES YES
Does employer plan Does employer plan
YES cover 60% or more of cover 60% or more of
NO
your share of health your share of health
expenses (on average)? expenses (on average)?
NO YES
Option to accept
employer coverage
Option to accept OR buy coverage
Option to accept
employer coverage on Exchange and
employer coverage
Option to Option to accept OR buy coverage receive premium
OR buy coverage
accept employer employer coverage on Exchange or tax credits (and
on Exchange and
coverage (and OR buy coverage individual market cost-sharing
receive premium
receive premium on Exchange or without premium subsidies if
tax credits (and
assistance subsidies individual market tax credits OR buy income equal to
cost-sharing
if state offers) OR without premium catastrophic-only or less than 250%
subsidies if income
enroll in Medicaid4 tax credits insurance5 OR opt FPL)6 OR buy
equal to or less
out of coverage catastrophic-only
than 250% FPL)6
without penalty insurance5 OR opt
out of coverage
without penalty
© Center for Healthcare Research Transformation, December 2011
www.chrt.org/ACAflowchart Page 2 of 2