The federal shape care reform legislation, known as the Patient Protection and Affordable Care Act, signed by the Head on March 23, 2010, and the Shape Care and Education Reconciliation Act approved by Congress, signed by the Head today, will expand the availability of shape care coverage to millions of Americans. While some of the measures will be implemented this year, many do not take effect until 2014 and some extend out to 2020.

Below is a high-level overview of the timeline.  It is vital to note that many of these reforms and their effective dates are subject to the policy and regulations process both at the state and federal levels – which could alter the intended timing of implementation.

2010

New Programs:
* Temporary retiree reinsurance program is established
* National risk pool is made, small business tax confidence is established
* $250 rebate for Medicare members who reach the “doughnut hole”

Insurance Reforms:
* Prohibits lifetime benefit limits – based on dollar amounts
* Allows top secret annual limits on the dollar value of certain repayment
* Coverage rescissions/cancellations are prohibited (except for fraud or intentional misrepresentation)
* Cost-sharing obligations for preventive services are prohibited
* Dependent coverage up to age 26 is mandated
* Internal and external appeal processes must be established
* Pre-existing condition exclusions for dependent children (under 19 years of age) are prohibited
* New shape plot leak and transparency requirements are made

2011

Insurance Reforms:
* Uniform coverage documents and standard definitions are developed
* Minimum medical loss ratios are mandated

Medicare Reforms:
* Medicare Advantage cost sharing limits effective
* Medicare beneficiaries who reach the doughnut hole will receive a 50% discount on brand name drugs
* A 10% Medicare bonus will be provided to primary care physicians and general surgeons practicing in underserved areas, such as inner cities and rural communities.
* Medicare Advantage plans would start to have their payments frozen.

Other:
* Employers are required to report the value of shape care repayment on employees’ W2 tax statements.
* Annual industry fee for pharmaceutical manufacturers of brand name drugs.
* Voluntary long term care insurance program would be made available to grant cash benefit for assisting disabled individuals to stay in their homes or cover nursing home expenditure. Repayment would start five years after people start paying a fee for coverage.
* Funding for community shape centers would be increased to grant care for many low returns and uninsured people.

2012

* Hospitals, physicians, and payers would be encouraged to band together in “accountable care organizations.”
* Hospitals with high rates of preventable readmissions would face reduced Medicare payments.

2013

* Individuals making $200,000 a year or couples making $250,000 would have a higher Medicare payroll tax of 2.35% on earned returns —up from the current 1.45%. A new tax of 3.8% on unearned returns, such as dividends and interest, is also added.
* Medical expense contributions to flexible spending accounts (FSAs) limited to $2,500 a year—indexed for inflation. In addition, the thresholds for claiming itemized tax deduction for medical expenses rise from 7.5% to 10% of returns.
* Medical device manufacturers would have a 2.9% sales tax on medical devices; devices such as eyeglasses, contact lenses, and hearing aids would be exempt.
* Eliminates deduction for expenses allocable to Medicare Part D subsidy for employers who maintain prescription drug plans for their Medicare Part D eligible retirees.

2014

Coverage Mandates & Subsidies:
* Individual and employer coverage responsibilities are effective. 
* Individual affordability tax credits are made and small business tax credits are expanded.

Shape Insurance Exchange & Insurance Reforms:
* State individual and small group shape insurance exchanges operational.
* Guaranteed issue, guaranteed renewability, modified community rating and minimum benefit standards (“essential repayment” plot) effective. 
* Lifetime and annual dollar limits are prohibited for essential repayment.
* Pre-existing condition exclusions are prohibited.

Taxes & Fees:
* Addition of new taxes on shape insurers

Medicaid and Medicare Reform:
* Medicaid expanded to cover low returns individuals under age 65 up to 133% of the federal poverty level—about $28,300 for a family of four.
* Minimum medical loss ratio of 85% required for Medicare Advantage plans

2018

Taxes & Fees:
* Tax (“Cadillac tax”) imposed on employer sponsored shape insurance plans that offer policies with generous levels of coverage.

2020

Medicare Reform:
* Doughnut hole coverage gap in Medicare prescription benefit is fully phased out. Seniors continue to pay the standard 25% of their drug expenditure until they reach the threshold for Medicare catastrophic coverage.

Author  Resource: Simple To Insure ME http://www.easytoinsureme.com/