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Health care reform: A timeline to important changes

The Affordable Care Act is in the process of radically changing the landscape of health insurance in America. You can read details of the law at healthcare.gov. Here's what has already happened and what's coming.

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Already implemented:

  • Pre-existing Condition Insurance Plans will last until 2014. These will provide immediate access to coverage for people who have no insurance now due to health problems. The out-of-pocket premium will be capped at $5,950 for individuals and $11,900 for families.
  • The Early Retiree Reinsurance Program provides funds to help employers extend group health insurance to workers who retire between age 55 to 65. The program is scheduled to stop in 2014, when early retirees can take advantage of insurance exchanges.
  • Community health centers will be funded.
  • Healthcare.gov was created to give consumers a place to find health insurance comparison options and tools to pick appropriate coverage.
  • Free mammograms and colonoscopies: Health plans years beginning on or after Sept. 23 have to cover a number of preventive services like mammograms and colonoscopies for free. No deductible, co-pay or coinsurance. 
  • No health insurance rescissions: Health insurance companies cannot drop you from your individual health insurance plan if you get sick.
  • Children’s coverage: New individual plans and existing group plans cannot deny coverage to children with pre-existing conditions.
  • No lifetime caps: Insurers cannot place lifetime caps on coverage. Annual limits must be approved by the government.
  • Stay on parent’s plan until age 26: Adult children will be eligible for coverage as dependents on their parents' policies until they are 26, unless they have access to health insurance through a job.
  • Appeal denials: New plans must include a way to appeal coverage determinations or claims. An external review process must also be established.
  • No lifetime dollar limits: Lifetime dollar limits on essential benefits, like hospital stays, are no longer allowed.
  • Medical loss ratio: Individual health insurance plans and small-group insurance plans must spend 80 percent of premiums on medical services, while large group plans have to spend at least 85 percent. If health insurance companies don’t meet these levels, they will have to give rebates to policyholders.
  • Discount on prescriptions for seniors: Seniors who fall into that "donut hole" gap will receive a 50 percent discount on Medicare Part D covered brand-name prescription drugs.
  • Free preventive care from Medicare, like annual wellness visits with no co-payments.
  • Electronic medical records: Health plans must begin implementing ways to exchange confidential medical information.

2013:

  • More taxes: Families who make $250,000 or more ($200,000 or more for singles) will pay more in Medicare payroll taxes. Unearned income on this group will also be taxed.
  • Flexible spending accounts: Those who utilize flexible spending accounts will be limited to $2,500 in contributions. This number will be adjusted yearly for the cost of living, and these plans will no longer allow reimbursement for over-the-counter medications. The threshold for deducting out-of-pocket medical expenses on your taxes will rise from 7.5 percent of income to 10 percent. (People over age 65 will remain at the 7.5 percent deduction threshold through 2016.)
  • Medicaid programs will receive new funding to cover preventive services, meaning more access for more patients.
  • The Children’s Health Insurance Program (CHIP) will receive funding for two more years on Oct. 1, 2013.

2014:

  • Individual mandate: Most individuals will be required to buy health insurance. Both individuals will face penalties for non-compliance, and employers will face penalties for not offering group health plans.
  • Pre-existing conditions: As of Jan. 1, 2014, health  insurers may no longer deny coverage or refuse to renew coverage to people with pre-existing conditions. They also may not charge higher premiums based on gender or pre-existing conditions.
  • No annual limits: Annual limits on coverage are no longer allowed for new plans and existing group plans.
  • Health insurance exchanges: If your employer doesn’t offer health insurance, you will have the option to buy affordable health insurance through state-run insurance marketplaces called exchanges. If you have coverage through your employer but your policy covers less than 60 percent of costs, or you pay more than 9.5 percent of your income to get that coverage, you can buy subsidized coverage. If you still can’t afford the insurance coverage offered by your employer, you can take the funds they would have contributed to the group plan and use them to buy potentially cheap health insurance from the exchange.
  • Health insurance subsidies: Families with income up to 400 percent of the federal poverty level (about $43,000 for an individual or $88,000 for a family of four) will earn subsidies to buy health insurance.
  • Medicaid expansion: Families who earn less than 133 percent of the poverty level (about $14,000 for an individual and $29,000 for a family of four) can enroll in Medicaid.  
  • Insurance companies will be banned from charging higher premiums because of a person's sex or health status.
  • Small-group health plan deductibles will be limited to $2,000 for individuals and $4,000 for families. Contributions can be offered to offset any amounts above these amounts.
  • Waiting periods for health insurance coverage will be capped at 90 days.
  • The Medicare Part D out-of-pocket maximum that enrollees pay for catastrophic coverage will be lowered.
  • Clinical trials: Health insurance companies many not drop or limit coverage for patients who choose to participate in a clinical trial for treatment for a life-threatening disease.

2015:

  • Doctors’ pay will be tied to quality of care rather than volume of patients.

2018:

  • A 40 percent excise tax on high-end policies (that is, health insurance plans with annual premiums of $10,200 for individuals and $27,500 or more for families) will be imposed. It is unclear who will have to absorb this cost: consumers or employers.

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