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 Health Care Reform Timeline 

The Affordable Care Act (ACA) affects everyone — healthcare providers and facilities, employers, individuals, and insurance health plans such as Optima Health. The information in this timeline on key ACA regulations and programs will help you gain a better understanding of all the changes taking place over several years.

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2018

  • High-Value Plan Excise Tax (Cadillac Tax)

    Employers pay a tax if their health insurance is high priced -- over $10,200 for an individual or $27,500 for a family annually. The plans include features, such as low or no Copayments and no Deductibles that promote over-using medical care.

    This provision affects employers and individuals.


2017

  • Exchange Opens to all Fully Insured Employers

    All employers with fully insured health plans may now purchase group plans for their employees through the Exchange (pending state approval).

    This provision affects employers and individuals.


2016

  • Exchange Opens to Employers with 51-100 Employees

    Implementation: 2016

    Employer groups with 100 or fewer employees may purchase health plans from the Small Business Health Options Program (SHOP). Previously, only employer groups with 2-50 employees were eligible.

    This provision affects employers.

  • Employer Mandate (50-99 employees)

    Employers with 50-99 or more full-time employees and equivalents must offer health insurance to its full-time employees or pay a penalty.

    This provision affects employers.


2015

  • Exchange Opens to CHIP Eligible Individuals

    Implementation: 2015

    Each state has an exchange, a group of insurers who offer affordable health insurance. People with the Children’s Health Insurance Program (CHIP) may use the exchange.

    This provision affects individuals.

  • Physician Payments Based on Quality of Care

    Implementation: January 1, 2015

    Medicare providers are paid differently by the Centers for Medicare and Medicaid Services (CMS). CMS bases payments on the quality of care instead of the quantity.

    This provision affects individuals.

  • Employer Mandate (100+ employees)

    Implementation: January 1, 2015

    Employers with 100 or more full-time employees and equivalents must offer affordable health insurance coverage or pay a penalty.

    This provision affects employers.


2014

  • Waiting Period Limits

    Implementation: January 1, 2014

    An employer waiting period cannot exceed 90 days from date of hire.

    This provision affects employers and individuals.

  • Rating Restrictions

    Implementation: January 1, 2014

    Health insurers can only consider geographic area, age, and tobacco use when setting prices. Rating restrictions limit how much insurers are allowed to adjust rates based on these factors.

    This provision affects employers, health plans and individuals.

  • Removal of Pre-Existing Conditions Exclusions

    Implementation: January 1, 2014

    Insurers must offer coverage to everyone, even people with health conditions.

    This provision affects employers, health plans and individuals.

  • Mandatory Coverage for Clinical Trials

    Implementation: January 1, 2014

    Insurers cannot cancel or limit coverage because a person is part of a clinical trial treating a life-threatening disease.

    This provision affects employers and individuals.

  • Individual Mandate

    Implementation: January 1, 2014

    Most everyone will be required to have health insurance or pay a penalty. This includes employer-sponsored coverage, individual coverage, or a government program such as Medicare or Medicaid.

    This provision affects individuals.

  • Deductible Caps on Health Insurance Plans

    Implementation: January 1, 2014

    Individual and small businesses (2-50 employees) health plans limit yearly costs, including Deductibles, Copayments, and Coinsurance. The limit equals the Health Savings Account Plan limit, about $6,350 for a single-person and $12,700 for a family in 2014. Individuals and families meeting income levels and purchasing certain health plans can limit their costs further.

    This provision affects employers and individuals.

  • Transitional Reinsurance Contribution

    Implementation: January 1, 2014

    Health insurers pay an annual fee for three years. The fees help cover high-risk individuals’ healthcare. The government predicts total fees for 2014 to 2016 at $25 billion.

    This provision affects employees and health plans.

  • Health Insurer Fee

    Implementation: January 1, 2014

    Health insurers pay an annual fee to fund federal and state health exchanges. The government predicts total fees for 2014 at $8 billion.

    This provision affects employers and health plans.

  • Essential Health Benefits

    Implementation: January 1, 2014

    Non grandfathered health insurance plans in the individual and small group markets must offer the following 10 essential benefits:

    • ambulatory patient services;
    • emergency services;
    • hospitalization;
    • maternity and newborn care;
    • mental health and substance use disorder services, including behavioral health treatment;
    • prescription drugs;
    • rehabilitative and habilitative services and devices;
    • laboratory services;
    • preventive and wellness services and chronic disease management; and
    • pediatric services, including oral and vision care.

    This provision affects employers, health plans and individuals.

  • Wellness Program Requirements

    Implementation: January 1, 2014

    The government encourages wellness programs. The programs are open to all employees, regardless of their health. They can be linked to health insurance discounts. Any rewards linked to specific health goals must also be linked to alternative goals to include as many people as possible.

    This provision affects employers and individuals.

  • Small Business Health Insurance Tax Credit Phase II

    Implementation: January 1, 2014

    Employers who qualify can receive tax credits when they pay for at least half of the cost of employees’ health insurance premiums. The credit may be as high as 50 percent of the premium costs and up to 35 percent for small non-profit organizations.

    This provision affects employers.

  • Guaranteed Issue

    Implementation: January 1, 2014

    Health insurers allow everyone to buy insurance — regardless of their health or past medical conditions.

    This provision affects individuals.

  • Elimination of Annual Limits on Health Insurance Coverage

    Implementation: January 1, 2014

    New health plans and existing group plans cannot limit how much they pay for a person’s health bills each year.

    This provision affects employers and individuals.

  • Health Insurance Subsidies for Qualified Individuals

    Implementation: January 1, 2014

    People with incomes between 100 and 400 percent of the poverty level may receive tax credits. These credits help lower the cost of health insurance premiums. People might also qualify for lower Copayments, Deductibles, and Coinsurance.

    This provision affects individuals.

  • Medicaid Expansion

    Implementation: January 1, 2014

    People making less than 133 percent of the Federal Poverty Level would be eligible for Medicaid. The limits are approximately $14,000 for an individual and $29,000 for a family of four annually. States receive money from the federal government to support the expanded coverage.

    This provision affects individuals.

  • Health Insurance Marketplace

    Implementation: January 1, 2014

    Health insurers offer affordable plans for small businesses and individuals. The health plans meet new requirements set by the government. Small businesses and individuals choose their plans.

    This provision affects employers and individuals.


2013

  • Administrative Simplication

    Implementation: 2013

    Health plans and certain health providers complete paperwork and electronic transactions the same way. With everyone working alike, the process is easier and costs less.

    This provision affects employers, individuals, health plans and hospitals.

  • Open Enrollment in the Health Insurance Marketplace

    Implementation: October 1, 2013

    Small businesses and individuals may buy affordable health insurance that meets new government standards. The benefits start as early as January 1, 2014.

    This provision affects employer and individuals.


2012

  • Patient-Centered Outcomes Research Fee

    Implementation: October 1, 2012

    Health plans pay a fee for research to determine best care practices.

    This provision affects employers and health plans.

  • Value-Based Purchasing Program

    Implementation: October 1, 2012

    The Center for Medicare and Medicaid Services rewards hospitals for the quality of care they provide to Medicare recipients. Successful hospitals follow best clinical practices and improve patients’ experiences.

    This provision affects hospitals.

  • Uniform Summary of Benefits and Coverage and Glossary

    Implementation: September 23, 2012

    All health plans share details of their benefits on a standard Summary of Benefits and Coverage (SBC) form. The form includes a glossary of terms. The information makes it easy to compare health plans.

    This provision affects health plans and individuals.

  • Women’s Preventive Services at No Cost Sharing

    Implementation: August 1, 2012

    Health plans offer more women’s preventive services, such as well-women visits and contraception, with no cost to the patient.

    This provision affects employers and individuals.

  • Accountable Care Organizations (ACO)

    Implementation: January 1, 2012

    Healthcare providers and health plans work together to improve health, affordability, and patients’ experiences. The groups focus on primary care and are accountable for results. The government can reward the groups for lowering costs and improving quality.

    This provision affects health plans and individuals.


2011

  • Non-Discrimination Rules for Insured Plans Section 105 (h)

    Implementation: 2011

    Employers cannot offer certain employees, such as those earning high salaries, extra health plan benefits or lower health plan costs.

    This provision affects health plans and individuals.

  • Community First Choice Option

    Implementation: October 1, 2011

    States can give Medicaid recipients with disabilities care at home, and use community-based attendant services instead of in an institution.

    This provision affects individuals.

  • FSA/HSA/HRA Changes

    Implementation: January 1, 2011

    Unless they have a prescription, buyers cannot be reimbursed through a Flexible Spending Account (FSA), Health Savings Account (HSA), or Health Reimbursement Account (HRA) for over-the-counter medications. Also, people making non-qualified HSA withdrawals will be taxed at 20 percent.

    This provision affects individuals.

  • Community Care Transitions Program

    Implementation: January 1, 2011

    The program tests ways to improve transitions from hospitals to other medical care centers. It also tests ways to reduce hospital readmissions for high-risk Medicare recipients.

    This provision affects individuals.

  • Center for Medicare and Medicaid Innovation

    Implementation: January 1, 2011

    The center looks for new ideas to lower costs and improve the quality of care.

    This provision affects individuals.

  • Medical Loss Ratio

    Implementation: January 1, 2011

    Health plans report the percentage of premiums paid for medical claims and efforts to improve the quality of care. The percentage must be at least 80 percent for individual and small group plans and at least 85 percent for others. Health plans pay rebates if they do not meet the requirements.

    This provision affects employers, health plans and individuals.

  • Medicare Part D “Donut Hole” Drug Coverage

    Implementation: January 1, 2011

    People reaching the coverage gap with Medicare Part D receive a 50 percent discount on covered brand-name drugs and a 7 percent discount on generic drugs while in the Donut Hole. The discounts increase until 2020 when the gap is closed.

    This provision affects individuals.


2010

  • Community Health Center Funding

    Implementation: 2010

    The federal government provides funding to expand health centers and care for nearly 20 million new patients.

    This provision affects individuals

  • Prevention and Public Health Fund

    Implementation: March 23, 2010

    The fund is dedicated to improving people’s health. It provides money for public prevention and health programs.

    This provision affects individuals.

  • Consumer Assistance Programs

    Implementation: 2010

    With federal funding, states provide ombudsmen to help people understand health plans and related legal concerns.

    This provision affects individuals.

  • Primary Care Workforce Rebuild

    Implementation: 2010

    Scholarships and favorable loan repayment plans are available for primary care doctors, nurses, and physician assistants working in underserved areas. Some repayment programs make loan payment amounts tax free.

    This provision affects individuals.

  • Holding Insurers Accountable For Premium Increases

    Implementation: 2010

    States that require health plans to justify premium increases can apply for grants. Plans with excessive or unjustified premium increases could be excluded from exchanges in 2014.

    This provision affects health plans.

  • Prohibiting The Denial of Coverage for Children with Pre-Existing Conditions

    Implementation: September 23, 2010

    New plans and existing group plans must cover children under age 19 with pre-existing conditions.

    This provision affects employers and individuals.

  • Regulation of Annual Insurance Coverage Limits

    Implementation: September 23, 2010

    New health plans in the individual market and all group health plans cannot set yearly dollar limits on a person’s coverage. In 2014, they cannot set yearly limits on essential benefits.

    This provision affects employers and individuals.

  • Elimination of Lifetime Limits

    Implementation: September 23, 2010

    Health plans cannot set lifetime dollar limits on essential benefits.

    This provision affects employers and individuals.

  • Introducing Initial Appeal Review Standards

    Implementation: September 23, 2010

    Consumers have a way to appeal health plan decisions. The government also provides an external process they can use to have decisions reviewed.

    This provision affects health plans and individuals.

  • Prohibiting Rescission of Coverage

    Implementation: September 23, 2010

    Health plans cannot search enrollees’ applications for errors and use mistakes to deny payments.

    This provision affects health plans and individuals.

  • Preventive Care Services with No Cost Sharing

    Implementation: September 23, 2010

    New health plans must cover some preventive services, such as mammograms and colonoscopies, without charging a Deductible, Copayment, or Coinsurance.

    This provision affects employers and individuals.

  • Extension of Adult Child Coverage Until Age 26

    Implementation: September 23, 2010

    In many cases, young adults can stay on their parent’s health plan until age 26. Employees should check with their employers for details.

    This provision affects employers and individuals.

  • Consumer Information Available at Healthcare.gov

    Implementation: July 1, 2010

    HealthCare.gov gives people information on health plans and helps them pick a plan that works for them.

    This provision affects employers and individuals.

  • Pre-Existing Condition Insurance Plan

    Implementation: July 1, 2010

    States or the Department of Health and Human Services offers the plan. People without a health plan for at least six months because of pre-existing conditions qualify for the plan until 2014. In 2014, the government prohibits all discrimination against pre-existing conditions.

    This provision affects individuals.

  • Early Retiree Reinsurance Program (ERRP)

    Implementation: June 1, 2010

    The government provides $5 billion in financial help. The money allows some early retirees to keep their employee-based health plans until Medicare or exchange plans are available.

    This provision affects employers.

  • More People Covered Under Medicaid

    Implementation: April 1, 2010

    The federal government gives states matching money so they can cover “some additional low-income individuals and families under Medicaid for whom federal funds were not previously available.”

    This provision affects individuals.

  • Small Business Health Insurance Tax Credit Phase

    Implementation: 2010

    Small for-profit and not-for-profit organizations can receive a tax credit to help them provide health benefits to their employees. The total credit can be as high as 35 percent of for-profit employer’s contribution toward the annual premium and 25 percent for small non-profit organizations.

    This provision affects employers.

  • The Affordable Care Act Becomes Law

    Implementation: March 23, 2010

    President Obama signs the Patient Protection and Affordable Care Act (also known as Health Reform). It is a law with many changes that happen over several years. The goal is to make quality healthcare available and affordable for all.

    This provision affects employers, health plans, hospitals and individuals.