2010

2011

2012

2013

2014

• Lifetime Coverage limits will be eliminated and annual limits are to be restricted; after 2014 they are prohibited.
• Pre-existing condition waiting periods for children under 19 are prohibited.
• Rescissions are prohibited except in cases of fraud.
• Lifetime limits on essential benefits are prohibited.
• Young adults will be able to stay on their parents' health plans until the age of 26 unless they have other coverage.
• Medicare Part D beneficiaries entering into the "doughnut hole" coverage gap in 2010 will get a $250 rebate.  Beginning July 1, eligible beneficiaries would automatically receive a 50% discount off the negotiated price for brand named drugs not covered under Part D.
• A tax credit becomes available for some small businesses to help them provide coverage for workers.
• Certain preventive services must be covered.
• HHS, in consultation with the states, must create an internet portal through which an individual may identify affordable health insurance coverage options no later than July 1.

• Employers are required to disclose the value of health benefits on employees' W-2 tax forms.
• OTC drugs excluded from HSAs/FSAs
• 85% medical cost ratio for large group; 80% medical cost for small group fully insured health plans are mandated...

• Within 24 months of enactment, all plans must provide benefit summaries that make it understandable to the average reader, require uniform definitions set by HHS; must state whether essential benefits are met.
• Physician payment reforms are implemented in Medicare to encourage doctors to form "accountable care organizations" to improve quality and efficiency of care.
• An incentive program is established in Medicare for acute care hospitals to improve quality outcomes.
• Fee caps start for Medicare Advantage plans; "quality" bonus phases in.

• The threshold for claiming medical expenses on itemized tax returns is raised to 10.0% from 7.5% of adjusted gross income.  The threshold remains at 7.5% for seniors aged 65 and older through 2016.
• The Medicare payroll tax is raised to 2.35% from 1.45% for individuals earning more than $200,000 and married couples with incomes over $250,000.  The tax is imposed on some investment income for that income group.

• Guarantee issue rules begin = rate variation based only on age (3:1 ratio); area; family composition; and tobacco use (1.5:1 ratio)
• Plans are prohibited from including annual benefit limits.
• 90 day limit on waiting periods for coverage.
• Health plans can no longer exclude anyone from coverage due to pre-existing conditions.
• States allowed to merge individual with small group markets.
• Standard "documentation" requirements imposed.
• State health insurance exchanges for small businesses and individuals open.
• Most people will be required to obtain health insurance coverage or pay a small penalty.  Health care tax credits become available to help people with incomes up to 400% of the poverty level purchase coverage on the exchange.
• Employers with an average of 50 or more workers who do not offer minimum essential coverage and have one employee receiving premium assistance are subject to an annual fee.  The first 30 employees aren't counted for the fine.
• Health insurance companies begin paying fee based on their market share.