Thought 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 http://jec.senate.gov/republicans/public/_files/SFCMarkFlowchart92209.pdf

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