Health Reform: A Timeline

Here's a look at when key changes will take effect.


On March 23, President Obama signed into law a sweeping reform of the nation's healthcare system. When will the changes that most affect consumers kick in?


  • Medicare recipients are now receiving a $250 rebate when they hit the "doughnut hole" gap in Part D drug coverage.
  • Businesses that employ fewer than 50 people are eligible for a tax credit equal to 35 percent of health insurance premiums.
  • States can choose to establish temporary high-risk pools for people with preexisting conditions, similar to those for car insurance, until new health insurance exchanges are implemented in 2014.
  • A federal website,, has been set up to provide information on health insurance options in each state.
  • Effective September 23, insurers cannot exclude children with preexisting conditions from coverage.
  • Adult children may remain on their parents' policies until their 26th birthday, although many plans will institute this change only when their new policy year starts.
  • All new policies must cover preventive services such as cancer screening, with no out-of-pocket costs.
  • Insurers are barred from canceling coverage when a policyholder becomes ill.
  • Insurers can no longer set lifetime limits on the amount of benefits paid; annual limits are restricted and will be phased out.


  • A voluntary national insurance program will be established to cover home health services for the elderly.
  • Those hitting the "doughnut hole" will receive a 50 percent discount on brand-name drugs.
  • Medicare will offer free annual wellness visits and personalized prevention plans.
  • Small businesses that establish wellness programs will be eligible for grants.
  • Chain restaurants and vending machine companies must disclose the nutritional content of their products.
  • Medicare will pay a 10 percent bonus to primary care physicians practicing in areas with doctor shortages.


  • The Medicare payroll tax rate will rise from 1.45 percent to 2.35 percent on earnings over $200,000 for individuals and $250,000 for couples.
  • The minimum threshold for claiming deductions for medical expenses will increase from 7.5 percent to 10 percent of adjusted gross income for those under 65.
  • Contributions to a flexible spending account will be limited to $2,500 per year.
  • The employer tax deduction for subsidizing Medicare Part D-eligible retirees will be eliminated.


  • U.S. citizens will be required to buy health insurance or pay a penalty of $95 per person in 2014, $325 in 2015, and $695 or up to 2.5 percent of income in 2016. After 2016, penalties will be indexed. The working poor may qualify for subsidies
  • Companies with 50 or more employees generally must offer health insurance or pay a penalty of $2,000 per employee after the first 30.
  • Insurers will not be allowed to refuse coverage because of preexisting conditions and cannot charge higher rates because of health status, race, or gender.
  • Health insurance exchanges will be available in each state, allowing individuals and small firms to comparison shop for a standardized policy.
  • Employers can offer rewards of 30 percent to 50 percent off the cost of coverage to employees who participate in wellness programs.


  • An excise tax will be imposed on employers who provide their workers costly "Cadillac" health plans, those with premiums beyond $27,500 annually for family coverage and $10,200 for individuals. Companies can choose to pay the tax, pass it on to employees, or lower the benefit.