“If you like your doctor, you can keep your doctor.” Keeping your doctor under the Senate Democrats’ bill* is as easy as ....
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Senate Diagram Of Health Care Proposal


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you might want to see the updated health care flow chart now that the
Democrats in the US Senate are attempting to make this scheme less
complex than the House version. Check out this link


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Senate Diagram Of Health Care Proposal

  1. 1. “If you like your doctor, you can keep your doctor.” Keeping your doctor under the Senate Democrats’ bill* is as easy as . . . I want to receive care from my Dr. Am I covered? PRIVATE COVERAGE INSURANCE EXCHANGE COVERAGE OPTIONS GOVERNMENT COVERAGE EMPLOYER SPONSORED INSURANCE HEALTH INSURANCE EXCHANGE NO Am I otherwise eligible for Defense NO Exchange coverage? YES CHAMPUS/TRICARE Has DHHS Is my ESI NO CO-OP Private plan Does my YES Title I, subtitle E employer grandfathered in offered OR OR my small group offer me outside the Am I eligible for Title I, subtitle B VA YES coverage? coverage? Exchange? federal Exchange subsidies Title I, subtitle A NO Veterans’ health system YES (MAGI=134-300% FPL)? Title I, subtitle C OR Is my ESI provided through the Exchange? CMS Does my employer employ ≤ 50 workers? YES NO YES EMPLOYER SPONSORED INSURANCE Medicare FFS or managed Title I, subtitle B care plan Self-insured OR Fully insured Can I plan plan OR Has DHHS permitted afford Have I elected CMS & “larger firms” (>50 Are my ESI premiums my YES “unaffordable” Exchange YES an Exchange Medicaid/CHIP workers) to enter the NO coverage? plan or been State Managed Exchange? (>13% MAGI)? Title I, subtitle C auto-enrolled care plan OR Exchange NO Title I, subtitle B in one? INDIVIDUAL MARKET INSURANCE POLICY Title I, subtitles B, D Can I afford YES INDIVIDUAL MARKET INSURANCE NO non-Exchange YES ENROLLMENT STATUS ESI coverage? COVERAGE REGULATIONS NO YES Can I afford individual market Can I afford Health plan must Am I currently enrolled and paid up? coverage with the help of a individual market YES Health plan Has my employer shifted me into must be meet DHHS state high-risk pool? YES coverage? NO mandatory benefits Have I been disenrolled for failing NO the government CO-OP? acceptable coverage as set standards. to pay my premiums? Benefit Levels: YES Has DHHS grandfathered in my YES forth under Platinum individual market coverage? the NAIC Gold Do I fall into one of the NO Model Silver Title I, subtitle A Has my Exchange plan been suspended YES NO I’m categories of persons exempted from the Regulation. Bronze by DHHS or my State from receiving Title I, subtitle A payments for my coverage due to Have I uninsured. individual mandate? Title I, subtitle C Have I paid the penalty violations of law or regulations? provided for being uninsured? Title I, subtitles B, D proof Title I, subtitle D I’m that I’m insured DOCTOR ACCESS insured. to the TREATMENT ACCESS Is the treatment I need covered IRS? Does my Dr. participate in my Is my plan a private by my health plan? Title I, NO subtitle D health plan, i.e., accept its sector plan? PCORI reimbursement rates as I’m able to YES payment in full? Does my plan deny coverage of the treatment due to PCORI- receive FINANCIAL ACCESS IMAC Is my plan the funded research? care from Is my Dr. Do applicable government CO-OP or YES Title III, subtitle F my Dr. Can I afford Have the rate cuts imposed other government plan? NO willing rules permit my Dr. to to pay the by America’s Healthy to treat Future Act of 2009 and/or Is coverage of the treatment mandated by a DHHS me for accept cash whole cost YES YES in cash? proposed by IMAC caused regulation and/or by my State? I’m unable free? from me? NO YES Title I, subtitle A my Dr. to stop treating to receive Medicare patients? YES care from NO Title III, subtitle E Does my plan restrict NO Can I afford the cost-sharing? Am I eligible for this service as determined by an my Dr. access to my Dr.? YES electronic check with or without my “machine- Can I afford the higher cost- NO readable [health] identification card”? sharing due to the 35% high-cost Title III, subtitle G I’m unable NO plan tax and $2,000 FSA cap? to receive Title VI My Dr. is not in my health plan. My Dr. is in my health plan. YES care. My treatment is NO Am I eligible for an affordability not covered. My treatment is covered. cost-sharing tax credit of Ombudsman sufficient generosity? Title I, subtitle C MAGI: Modified adjusted gross Can I file a CHIP: Children’s Health Insurance Program FFS: Fee-for-service income Start Current government agency/program Question grievance CHAMPUS: Civilian Health & Medical Program for FPL: Federal poverty level PCORI: Patient-Centered Positive New government agency/program Added by bill with my State YES Uniformed Services FSA: Flexible Spending Arrangement Outcomes Research Inst. Negative New personal responsibility/penalty Ombudsman? Can I find a different Dr. or a clinic CMS: Centers for Medicare and Medicaid Services HBAC: Health Benefits Adv. Cmte. NAIC: Natl. Assn. of Insur. Title I, subtitle F willing to treat me for free? DHHS: Dept. of Health and Human Services IMAC: Independent Medicare Adv. Comm. Commissioners Source: Joint Economic Committee, Republican Staff http://jec.senate.gov/republicans NO * Finance Cmte. Chairman’s Mark, “America’s Healthy Future Act of 2009,” as released 9/16/09