‘‘(1) 
Children 
(as 
defined 
in 
section 
2261(a)(1)). 
‘‘(2) Low-income individuals (as defined in sec-
tion 2261(a)(2)). 
‘‘(3) Pregnant women (as defined in section 
2261(a)(3)). 
‘‘(c) RECIPROCAL COVERAGE OF NONRESIDENTS.— 
An individual who— 
‘‘(1) is not a resident of the United States, 
‘‘(2) is in the United States, and 
‘‘(3) is a national of a foreign state which pro-
vides health benefits to nationals of the United 
States who are nonresidents in that state, 
is entitled to such health insurance benefits under this 
title, but only to the extent the Secretary determines that 
such benefits would be available to nationals of the United 
States similarly situated as a nonresident in the foreign 
state. 
‘‘SEC. 2202. ENROLLMENT AND AMERICARE CARDS. 
‘‘(a) ENROLLMENT.—The Secretary shall provide a 
mechanism for the enrollment of individuals entitled to 
benefits under this title and, in conjunction with such en-
rollment, the issuance of an AmeriCare card which may 
be used for purposes of identification and processing of 
claims for benefits under this title. AmeriCare cards shall 
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identify (as appropriate) the date of birth (for purposes 
of identifying children) and provide a coded means for 
identifying whether the individual is a low-income indi-
vidual for the year involved. 
‘‘(b) CLASSES OF ENROLLMENT.—The mechanism 
under subsection (a) shall provide for individuals to be en-
rolled on the basis of the following classes of enrollment: 
‘‘(1) Coverage only of an individual. 
‘‘(2) Coverage of a married couple without chil-
dren. 
‘‘(3) Coverage of an unmarried individual and 
one or more children. 
‘‘(4) Coverage of a married couple and one or 
more children. 
‘‘(c) ENROLLMENT
AT
BIRTH.—The mechanism 
under subsection (a) shall include a process for the auto-
matic enrollment of individuals at the time of birth in the 
United States. 
‘‘(d) OPT OUT FOR THOSE COVERED UNDER GROUP 
HEALTH PLAN.—Notwithstanding any other provision of 
this title, an individual may elect not to be enrolled for 
benefits under this title if the individual demonstrates to 
the satisfaction of the Secretary that the individual has 
health benefits coverage under a group health plan (as de-
fined in section 5000(b)(1) of the Internal Revenue Code 
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of 1986) that is at least equivalent to the coverage other-
wise provided under this title, as certified by the Sec-
retary. 
‘‘PART B—BENEFITS 
‘‘SEC. 2221. SCOPE OF BENEFITS. 
‘‘(a) IN GENERAL.—Except as provided in the suc-
ceeding provisions of this part, the benefits provided to 
an individual described in section 2201(a) by the program 
established by this title shall consist of entitlement to the 
same benefits as are provided under parts A and B of title 
XVIII to individuals entitled to benefits under part A, and 
enrolled under part B, of title XVIII. 
‘‘(b) CHANGE IN THE COST-SHARING.— 
‘‘(1) DEDUCTIBLE.—Except as provided in the 
succeeding provisions of this part, the amount of ex-
penses (other than expenses for benefits described in 
subsection (c)) with respect to which an individual is 
entitled to have payment made under this title for 
any year shall first be reduced by a deductible of 
$350, except that in no case shall the amount of the 
deductible for all the members of a family exceed 
$500. Such deductible shall be instead of the deduct-
ible for inpatient hospital services under the first 
sentence of section 1813(a)(1) and the deductible 
under section 1833(b). 
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‘‘(2) COINSURANCE.—After the application of 
the deductible under paragraph (1), the expenses re-
ferred to in such paragraph shall be subject to a co-
insurance of 20 percent until the limit on out-of- 
pocket expenses under paragraph (3) is met. 
‘‘(3) LIMIT ON OUT-OF-POCKET EXPENSES AND 
TOTAL EXPENSES.— 
‘‘(A) LIMITATION
ON
COST-SHARING.— 
Subject to subparagraph (B), whenever in a cal-
endar year an individual’s expenses for the de-
ductible and coinsurance with respect to serv-
ices covered under this title (including expenses 
for benefits described in subsection (c)) and 
furnished during the year equals $2,500, or 
$4,000 for all the members of a family, pay-
ment of benefits under this title for the indi-
vidual (or for the members of such family, re-
spectively) for services furnished during the re-
mainder of the year shall be paid without the 
application of any coinsurance. 
‘‘(B) LIMITATION
ON
PREMIUMS
AND 
COST-SHARING
FOR
CERTAIN
INDIVIDUALS 
BASED ON INCOME.— 
‘‘(i) INCOME BETWEEN 200 AND 300 
PERCENT OF POVERTY LINE.—In the case 
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