“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