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2010 2011 2012 2013 2014 2018 2020
“Cadillac tax” is imposed.
Pre-existing condition exclusions are prohibited.
Hospitals with high rates of preventable readmissions face reduced Medicare payments.
Employers may report the value of health care benefits on employees’ W2 tax statements (optional for 2011 tax year/mandatory thereafter).
Dependent child coverage up to age 26 is mandated.
Expensive
Health plan
Individuals making $200,000 a year or couples making $250,000 have a higher Medicare payroll tax.
Insurance Reforms:
>Newuniformcoveragedocumentsandstandarddefinitionsaredeveloped(applicable2012).
>Mustmeetminimummedicallossratios.
>Raterequirementswillbeeffective.
Medicare Reforms:
>StartofMedicareAdvantagecost-sharinglimits.
>Medicarebeneficiarieswhoreachthedonutholetogeta50%discountonbrand-namedrugs.
>Primarycaredoctorsandgeneralsurgeonspracticinginunderservedareas,suchasinnercitiesandruralcommunitiestogeta10%Medicarebonus.
>MedicareAdvantageplansbeginrestructureofpaymentsandfreezes2011paymentsat2010level.
Other:
>Startofvoluntarylong-termcareinsuranceprogramgivingacashbenefittohelpthosewithdisabilitiesstayintheirhomesorpaynursinghomecosts;benefitstarts5yearsafterpayingcoveragefee.
>Increasedfundingforcommunityhealthcenterstoprovidecareformanylow-incomeanduninsuredpeople.
>Excludescostsforover-the-counterdrugsnotprescribedbyadoctorfrombeingreimbursedthroughaHSAorFSA.
>Employersmayreportthevalueofhealthcarebenefitsonemployees’W2taxstatements(optionalfor2011taxyear/mandatorythereafter).
>Startofnewannualfeesonpharmaceuticalmanufacturingsector.
New Programs:>Temporaryretireereinsurance
program.Specificcriteriaapply;limitedfunding.
>Nationalriskpool,smallbusinesstaxcredit.
>$250rebateforMedicarememberswhoreachthe”donuthole.”
Insurance Reforms:
>Nolifetimedollarlimitsonessentialbenefits.
>Allowedrestrictedyearlylimitsonthedollarvalueofcertainbenefits.
>Nocoveragerescissions/cancellations(exceptforfraudorintentionalmisrepresentation).
>Nocost-sharingobligationsforpreventiveservicesinnetwork.
>Musthavedependentchildcoverageuptoage26.
>Enhancedinternalandexternalappealprocessesandrequirements.
>Nopre-existingconditionexclusionsforenrollees(under19yearsofage).
Health Reform Timeline2010 –2020
New tax (“Cadillac tax”) on employer-sponsored health plans that offer policies with generous coverage levels.
Donut hole coverage gap in Medicare prescription benefit is fully phased out. Seniors continue to pay the standard 25% of their drug costs until they reach the threshold for Medicare catastrophic coverage.
Hospitals, doctors and payers encouraged to join forces in “accountable care organizations.”
Hospitals with high rates of preventable readmissions facing reduced Medicare payments.
Administrative Simplification rules required under ACA begin to phase in.
>Individualsmaking$200,000ayearorcouplesmaking$250,000wouldhaveahigherMedicarepayrolltaxof2.35%onearnedincome—upfromthecurrent1.45%.Anew3.8%taxonunearnedincome,suchasdividendsandinterest,alsoadded.
>Contributionstoflexiblespendingaccounts(FSAs)limitedto$2,500ayear—indexedforinflation.Andthethresholdfordeductingmedicalexpensesontaxesgoesfrom7.5%to10%ofincome.
>Medicaldevicemanufacturershavea2.9%salestaxonmedicaldevices;withexemptionsforsome,likeeyeglasses,contactlensesandhearingaids.
>NomoredeductionforexpensesallocabletoMedicarePartDsubsidyforemployerswhomaintainprescriptiondrugplansfortheirMedicarePartD-eligibleretirees.
Coverage Mandates & Subsidies:
>NewIndividualandemployercoverageresponsibilities.
>NewIndividualaffordabilitytaxcreditsandexpandedsmallbusinesstaxcredits.
Health Insurance Exchange & Insurance Reforms:
>Stateindividualandsmallgrouphealthinsuranceexchangesoperational.
>Guaranteedissue,guaranteedrenewability,modifiedcommunityratingandminimumbenefitstandards(“essentialbenefits”plan)effective.
>Nomorelifetimeorannualdollarlimitsforessentialbenefits.
>Nomoreexcessivewaitingperiods.
>Nopre-existingconditionexclusions.
>Newhealthplandisclosureandtransparencyrequirements.
>Newuniforminsuranceratingreforms.
>ProviderNon-discriminationrequirements.
New taxes on health insurers.
Medicaid and Medicare Reform:
>Medicaidexpandedtocoverlow-incomeindividualsunderage65upto133%ofthefederalpovertylevel—about$28,300forafamilyoffour.
>Minimummedicallossratioof85%requiredforMedicareAdvantageplans.
ThisTimelineisonlyahighlevellistingoftheprovisionswithinthePatientProtectionandAffordableCareAct(ACA).Informationcontainedhereinissubjecttochangeasregulationsareissuedandinterpretationevolves.ThisdocumentshouldnotbeconsideredtobelegalguidanceregardingACAoritspotentialimpact.
©2011AetnaInc.00.03.978.1B(5/11)
