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Health Care Reform Timeline


People with health insurance

  • Insurers may not arbitrarily cancel your coverage when you get sick, except in cases of fraud or intentional misrepresentation of an important fact on your application. (effective for plan years beginning on or after Sept. 23, 2010).
  • Insurers may not impose lifetime coverage limits and, until 2014, may only set restricted annual limits for essential health benefits as defined by the Department of Health and Human Services. (effective Sept. 23, 2010).
  • Insurers must cover preventive services with no co-payments or deductibles. (effective for plan years beginning on or after Sept. 23, 2010).


  • Adult children who don't get health care coverage from their employers may stay on their parents' plans until age 26. (effective for plan years beginning on or after Sept. 23, 2010). Grandfathered health plans (those that already existed when the healthcare reform law went into effect on March 23, 2010) will be required to cover only those adult children that do not have access to their own employer-group plans.
  • Insurers may not deny coverage to a dependent child age 18 and younger because of pre-existing conditions. The same will be true for adults and dependent children age 19 and older beginning in 2014. (effective for plan years beginning on or after Sept. 23, 2010).

Medicare beneficiaries

  • Eligible beneficiaries with Part D coverage who enter the "donut hole" in 2010 can receive a one-time $250 rebate to pay for prescription drugs that were purchased while in the donut hole. The rebate will be less for individuals earning more than $85,000 per year and for couples earning more than $170,000. The donut hole is the period of time during which some Medicare prescription drug plans won’t contribute anything toward your prescription costs. (began Jan. 1, 2010)


  • The healthcare reform law requires states to offer a temporary high risk pool for individuals with pre-existing conditions who have been uninsured for at least six months. This program becomes available on June 14, 2010, with premiums capped at the average cost of private coverage in each state’s individual health insurance market. The federally-mandated risk pools are temporary until exchanges become effective in 2014.
  • In North Carolina, the new federal temporary high risk pool will be administered by Inclusive Health, North Carolina’s existing state health insurance risk pool. Inclusive Health already offers lower-cost coverage to eligible North Carolina citizens with pre-existing conditions. The federal high risk pool will be available starting June 14, 2010. Please note that benefits and pricing may differ for the two risk pools. Contact Inclusive Health at or 1-866-665-2117 for more information.
  • In addition to the new risk pool, a new federal government Web site will be available by July 1 to help consumers shop for coverage.

Small businesses

  • Businesses with 25 or fewer full-time employees that pay for at least 50 percent of premiums and pay average annual wages below $50,000 may be eligible for a tax credit of up to 35 percent (25 percent for nonprofits) of the premiums the business pays. The credits increase in 2014. (began Jan. 1, 2010)


Insurance companies

  • For small group and individual plans, insurers must spend at least 80 percent of revenue from premiums on medical services and programs directly related to improving health care quality. The amount increases to 85 percent for large group plans. Insurers that fail to meet the minimum payment requirements must provide refunds to enrollees.

Medicare beneficiaries

  • Medicare beneficiaries with Part D coverage in the donut hole will begin receiving a 50 percent discount on brand-name drugs.
  • Co-payments and deductibles for preventive services will be eliminated.


Wealthier individuals and families

  • For individuals earning more than $200,000 per year and couples earning more than $250,000 per year, Medicare payroll taxes will increase.



  • Health care coverage will be required for U.S. citizens and legal residents. The tax penalty will be $95 or 1 percent of taxable income in 2014; $325 or 2 percent of taxable income in 2015; $695 or 2.5 percent of taxable income in 2016; and adjusted according to income every year after. There are exceptions for religious objectors, those who can't afford coverage, individuals below the tax-filing threshold, and various others.
  • States will create insurance marketplaces, known as "exchanges," for people and small businesses to buy coverage. U.S. citizens and legal residents who are not incarcerated would qualify to buy coverage in an exchange. States can expand their exchanges to provide coverage for large employers in 2017.
  • Premium subsidies will be available for individuals and families with incomes between 133 percent ($14,404 for individuals and $29,326 for a family of four) and 400 percent ($43,320 for individual or $88,200 for a family) of the federal poverty level.
  • States will be required to expand Medicaid to individuals under age 65 (children, pregnant women, parents, and adults without dependent children) who are up to133 percent of the federal poverty level. There is an option for states to expand Medicaid in 2011.

People with health insurance

  • Insurers may not deny you coverage because of pre-existing conditions. Similar provisions prohibiting insurers from denying coverage to children 18 and younger with pre-existing conditions begin in 2010.
  • Insurers must accept everyone who applies for coverage when they apply during a defined enrollment period.
  • Insurers can rate individuals on age, tobacco use, geographic area, and whether coverage is for an individual or a family, but not on health status/history.
  • Insurers may not deny coverage because of a person's health status, medical condition, claims experience, medication history, genetic information, or disability.


  • Large employers who don't offer employee health care coverage will pay $2,000 for each full-time worker who receives a tax credit for health insurance through a state exchange.
  • Tax credits for small employers increase to 50 percent (35 percent for nonprofits) of the health care premiums the business pays.
  • Businesses with more than 200 employees must automatically enroll employees in a health insurance plan. Employees can opt out.


Medicare beneficiaries with Part D coverage

  • The donut hole is eliminated.