ACA Timeline
Stay on top of various health reform facts and see the health reform legislation get implemented during the coming years.
2010
- Affordable Care Act (ACA) signed into law on March 23, 2010
- Extends coverage for young adults to age 26
- Prohibits denying coverage to people under age 19 based on pre-existing conditions
- Eliminates arbitrary cancellations or rescissions of coverage
- Provides rebate to Medicare Part D beneficiaries reaching "donut hole"
- Creates a temporary insurance plan for people with pre-existing conditions (new enrollments discontinued in February 2013)
- Small business tax credits available to eligible employers
- Eliminates lifetime dollar limits on coverage
- Restricts annual dollar limits on coverage
- Provides the right to appeal health plan coverage determinations
- Plan comparison information made available online
- Consumer assistance programs established
- Requires all new health plans to cover preventive services with no cost sharing to the member
- New resources allocated to reduce health care fraud
- Early retiree reinsurance program (ERRP) created
- Insurance companies held accountable for unreasonable rate increases
2011
- Medicare Part D prescription drug discounts provided in "donut hole"
- Income related Part D premium adjustments
- Medicare Advantage benefit and payment reforms
- Additional free preventive services added to Medicare
- Minimum Loss Ratios (MLR) for insurance companies take effect
- Penalties for non-qualified HSA distributions increased to 20%
- Limitations on the reimbursement of over-the-counter medications through HSAs/HRAs/FSAs
2012
- W-2 reporting requirements for calendar year 2012 (distributed in 2013)
- Summary of Benefits and Coverage (SBC)
- Patient-Centered Outcomes Research Institute (PCORI) fees start (payable in 2013 and applies to employers with 250+ W-2 employees)
- Value-Based Purchasing (VBP) program for Medicare
- Incentives provided to physicians that join Accountable Care Organizations (ACO)
- Efforts to reduce paperwork and administrative costs implemented
- Voluntary options for Long-Term Care (LTC) Insurance (eliminated from law)
2013
- Changes in the tax treatment of Medicare retiree drug subsidy received by employers
- Health Insurance Marketplaces (Exchanges) operational on October 1, 2013 (for 2014 effective dates). Online enrollment for small businesses delayed until November 2014.
- Employer notifications about Health Insurance Marketplaces begins
- Medicare tax adjustments for high income earners
- Excise tax on medical devices
2014
- Subsidies provided to some individuals and families earning up to 400% of federal poverty limit (FPL)
- Elimination of annual dollar limits Essential Health Benefits (EHB)
- Individual Mandate - must have coverage or pay a penalty (some exemptions apply)
- Prohibition of denying coverage expands to individuals of all ages
- Prohibits insurers from dropping or limiting coverage for participation in clinical trials
- Elimination of pre-existing condition waiting periods and other exclusions
- Small business tax credits increased, but only available to employers that offer coverage to employees through the Small Business Health Options Program (SHOP)
- Medicaid expansion (not all states participated in the expansion)
- Deductible limits to small group health plans - $2,000 individual / $4,000 family (exceptions apply to these limits if necessary to meet actuarial value standards of the Bronze, Silver, Gold or Platinum plans)
- Out-of-pocket limits apply to all market segments - tied to HSA out-of-pocket limits
- Transitional reinsurace fee starts (2014-2016). Self-funded plans are only subject to the fee in 2014
- Health Insurer fee starts (permanent)
- Waiting periods limited to 90 days
- Wellness incentives
2015
- Employer mandate applies to employers with 100 or more employees
2016
- Employer mandate applies to employers with 50 or more employees
- Employer reporting requirements start (based on coverage offered in prior year)
- SHOP exchange opens to employers with up to 100 employees
- Depending on a state’s small group market definition, the SHOP exchange may become available to employers with up to 100 employees
2017
- States have the option to expand Health Insurance Marketplaces to employers of all size
2018
- No ACA components to be released.
2019
-
Medicare Part D “donut hole” eliminated for brand name drugs
-
Individual Mandate penalty is $0
2020
- Medicare Part D “donut hole” eliminated for generic drugs
2021
- No provisions scheduled to take effect
2022
-
Cadillac Tax – assesses a 40% tax penalty against health plans that provide too rich of a benefits package
