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What is the overall timeline for Obamacare provisions of the to law take effect

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When Obamacare was first enacted in 2009, there were certain provisions that went into effect immediately, but the major pieces of the legislation have been rolled out in phases.

Below is a timeline that shows when the most important elements of the Patient Protection and Affordable Care Act aka Obamacare went into effect, as well as the portions of the law which are yet to be enacted.  (This timeline is limited to those parts of the law that impact consumers.)

Provisions Timeline

Effective at enactment – on or about March 23, 2010:

An independent non-profit group known as the Patient-Centered Outcomes Research Institute was formed to conduct comparative effectiveness studies that look at the clinical effectiveness, appropriateness, and relative health outcomes of various medical treatments.  By examining existing studies and conducting many of its own, this 19-member panel includes doctors, drug manufacturers, patients, hospitals, insurers, government officials and health experts.  Unlike the UK’s National Institute for Health & Clinical Excellence this institution is forbidden to use a “dollars per quality adjusted life year” or similar measure that uses an individual’s disability as a way to decide which type of health care is recommended.

Food vendors and chain restaurants with 20 or more locations are now required do display the caloric content of the food on their menus.  Other information, such as saturated fat and sodium content must be available to customers upon request.

Effective June 21, 2010:

Adults with preexisting conditions became eligible to join a high risk pool, which will eventually be replaced by the planned health-care exchange in 2014.  In order to qualify, applicants must have been uninsured for at least the past six months and must have a preexisting health condition.  By joining this pool, a member’s out-of-pocket spending must not exceed $5,950 for individuals and $11,900 for families, excluding the cost of premiums.

Effective September 23, 2010:

Insurers were prohibited from imposing a lifetime limitation on essential medical benefits such as hospitalization.

Dependent children are now permitted to remain on their parents’ health insurance policy until their 26th birthday.  This new part of the law includes dependents that no longer live with their parents, are no longer a student or are married.

Children under the age of 19 can no longer be denied coverage for pre-existing medical conditions, with the exception of grandfathered individual health plans.

All new health insurance policies must cover preventive care as well as Level A or B medical screenings.  In addition, insurers may not charge co-payments, coinsurance or deductibles for these services.

Insurers can no longer drop policyholders when they get sick.

Medicare was expanded to include small rural hospitals and facilities.

Effective January 1, 2011

Flexible spending accounts, health savings accounts and health reimbursement accounts can no longer be used to pay for over-the-counter drugs that do not require a prescription, with the exception of insulin.

Effective January 1, 2012

Employers are now required to disclose the value of the benefits they provide for each employee’s health insurance coverage and include this information on the annual form W-2.  However, this reporting is not required for employers who filed less than 250 W-2 forms in the preceding calendar year.

Effective by August 1, 2012

In addition to standard preventive care services, all new health plans must also cover mammograms and colonoscopies without every charging a deductible, co-insurance or co-pay.  Other Women’s Preventive Services provisions include coverage for contraception, breastfeeding equipment and domestic violence screenings without cost-sharing.

Effective by January 1, 2013

Starting in January 2013, income from self-employment and wages of single individuals who earn more than $200,000 annually will be subject to an additional tax of 0.9 percent.  For married couples filing jointly, the threshold is $250,000.  In addition, people with an adjusted gross income of more than $200,000 (or $250,000 for married couples filing jointly) will be subject to an additional Medicare tax of 3.8 percent on unearned income.

Effective by August 1, 2013

Any religious organizations that were granted a one-year extension for the contraceptive mandate will no longer be exempt.

Effective by January 1, 2014

Beginning in January 2014, the maximum amount of out-of-pocket premiums a family can pay will be determined under the PPACA using a calculation of their family size vs. the federal poverty level.

Insurers will no longer be allowed to charge higher rates for individuals based on a preexisting medical condition or their gender.

Individuals who are not covered by an acceptable insurance policy will be charged an annual penalty of $95, or up to 1 percent of the amount of income above the filing minimum, whichever sum is greater.  Exemptions to mandatory coverage may also be filed for religious reasons or by people whose least expensive policy would exceed 8 percent of their annual income.  While the Supreme Court ruled on June 28, 2012 that the individual mandate of health care coverage is unconstitutional, they ruled that this penalty can still be levied as a tax.

Insurers may no longer establish annual spending caps.

In certain states, where Medicaid eligibility is expanded, all individuals with an income of up to 133 percent of the poverty level will qualify for coverage, even adults without dependent children.  Originally, states that declined to participate in the expansion could not receive these benefits, nor could they take advantage of the additional funding.  However, the Supreme Court found that a withdrawal of funding was found unconstitutional and now states are able to opt out of the Medicaid expansion without jeopardizing their government subsidy.

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