Lots of big changes in the 2010 health care law have yet to take effect. Here’s how they are to unfold:
• Payroll taxes rise for individuals making more than $200,000 a year and couples above $250,000. These people are also hit with a 3.8 percent tax on investment income.
• A 2.3 percent excise tax begins on sales by medical-device makers.
• Taxpayers must spend more on unreimbursed medical care before claiming itemized deductions.
• Start of program to encourage creation of nonprofit, member-run health insurers in each state.
• Almost everyone required to be covered by either private or government-run insurance or pay a penalty to the IRS.
• Most employers face penalties if they don’t offer coverage to their workers.
• Insurers prohibited from rejecting people with medical problems or charging them more.
• Insurers can’t charge women more than men.
• Medicaid program for the poor expands in states that take part: It covers childless adults for the first time. And it takes in people with incomes up to 133 percent of the federal poverty level, or $29,327 a year for a family of four.
• Newly created, state-based insurance markets make it easier for individuals and small businesses to find and compare coverage.
• Subsidies help many people, including some upper-income families, buy coverage through the state markets.
• Tax credits to help pay for health plans at businesses with 25 or fewer workers reach their maximum. For businesses with 10 or fewer employees, the credits will cover 50 percent of the cost of premiums.
• New fee on health insurers begins.
• New limits on savings in flexible spending accounts begin.
• A 40 percent tax on high-cost, employer-sponsored health plans begins. The tax falls on plans worth more than $10,200 for individuals and $27,500 for families.
• The gap in Medicare’s prescription drug coverage, known as the “doughnut hole,” is fully eliminated after years of phase-out. After that, seniors will pay 25 percent of the cost of their medications up until Medicare’s catastrophic coverage kicks in.
Many provisions are already in effect, including:
• Co-payments for preventive care for all ages have been eliminated.
• Young adults can stay on their parents’ insurance up to age 26.
• Insurers can’t deny coverage to children with health problems.
• Policies can’t limit how much they’ll pay over a person’s lifetime.
• Older people save money through improved Medicare prescription benefits, which are phasing in through 2020.
• A temporary program helps people with pre-existing health problems get coverage.
• Cuts in reimbursements for hospitals and insurers under Medicare have started and will cut deeper over time.