Health Care Reform Law Timeline

Health Care Reform Law Timeline

Final Regulations have yet to be released by the Department of Health and Human Services to clarify transition details. Summary information provided is subject to change and clarification.


  1. Grandfathered health plans are defined as in effect on 3/23/2010, and must comply with all new standards when benefit changes are introduced; Bargained plans grandfathered until next collective bargaining agreement.
  2. Even if grandfathered, required changes the first plan year renewal after 9/23/2010:
    A. Lifetime maximums eliminated for essential benefits
    B. Health plans must cover pre-existing conditions for children until 19
    C. Children may be covered under a parent’s plan to age 26 unless   eligible for another employer’s plan
  3. $250 rebate to Medicare Part D Rx enrollees
  4. Temporary national re-insurance program for age 55 – 64 in retiree plans
  5. Temporary national high risk pool for long term uninsured and individuals with pre-existing conditions


  1. Pre-tax payment in FSA, HRA & HSA eliminated for Over the Counter products unless prescribed by a licensed physician
  2. Medicare Advantage payments to insurers frozen; Reductions in payments phased in over next 3 to 7 years
  3. Health insurer loss ratios of 80% for individual & small group plans; 85% for large group plans; Panel to monitor future insurance premium rate increases
  4. Unless grandfathered as of 12/31/2010, no physician ownership of hospitals allowed where patients referred
  5. Government fees added to brand name pharmaceuticals
  6. 20% early withdrawal penalty in HSAs for non health care use
  7. The value of health benefits included on 2011 IRS Form W-2 (delayed)
  8. 50% discount on Part D brand prescriptions filled in Donut hole
  9. CMS Innovation Center to develop new pricing approaches; Community Health Centers & Medical Home program expansion; Value Based Purchasing for Hospital Providers; Comparative Effectiveness Research Commission for standardization of care


  1. Uniform group health plan language to explain health benefits plan coverage (delayed)
  2. Requirement to notify participants of material health plan changes at least 60 days prior to effective date(delayed)
  3. Government tax for insured and self funded plans of $1 per average number of members covered


  1. Taxation of Medicare Part D Subsidy payments to employers
  2. Flexible Spending Accounts annual deferral maximum of $2,500
  3. Primary physicians reimbursed 100% of Medicare rates for Medicaid patients
  4. 2.3% Excise tax on medical devices
  5. Government tax for insured and self funded plans increased to $2 per average number of members covered
  6. Bundled payment pilot programs for providers of care
  7. Medicare Tax increased from 1.45% to 2.35% for individuals with modified adjusted gross income incomes of $200,000 single and $250,000 joint returns. Investment income derived from interest earnings, dividends, royalties, rents, and net gains from sales of property unless held in a business taxed at 3.8%


  1. Establishment of Health Insurance Exchanges offering plans through private insurers for individuals & small businesses up to 100 employees
  2. Health plans required to cover pre-existing conditions for adults
  3. Tax penalties to individuals that do not purchase and maintain health insurance on a sliding scale with from $325 to $695 or 1% to 2.5 % of income whichever is greater
  4. Fines to employers with 50+ full time & part time employees equal to $2,000 per full time employee not insured under the employer’s plan; excludes first 30 employees not covered
  5. Employers with 200 or more employees required to auto-enroll new hires in lowest cost plan option
  6. Introduces a maximum new hire waiting period of 90 days following date of employment (unless grandfathered)
  7. Catastrophic coverage available for individuals under age 30
  8. Essential Benefits package required (unless grandfathered) including deductible maximums of $2,000 single & $4,000 family for small groups
  9. Medicaid coverage for individuals below 133% of poverty line. 100% Federal Government funding 2014 – 2016; 95% in 2017; 94% in 2018; 93% in 2019; 90% in 2020 and beyond
  10. Grandfathered plans must comply with new standards including
    A. No pre-existing exclusions for all enrollees
    B. Maximum waiting period for new full time employees up to 90 days
    C. Elimination of annual benefits coverage limits
    D. Preventive Benefits must be covered at 100%
    E. Coverage for children until age 26 even if eligible under another employer’s plan


  1. Implementation of 40% Excise Tax for plans with premiums in excess of $10,200 Single and $27,500 Family indexed for inflation; open to change if health care inflation varies from projections
  2. Grandfathered plans must comply with all new standards including:
    A. coverage for individuals participating in a clinical trial
    B. Out of pocket maximum equal to High Deductible Health Plans (HDHPs)


  • Part D Donut Hole phased out; 25% cost responsibility maintained for prescription medications