2010

• Medicare beneficiaries will receive a $250 rebate when they reach the gap in coverage for prescription drugs, known as the "doughnut hole." The gap exists when total costs exceed $2,830 until they reach $6,440.

• A national high-risk insurance pool will offer insurance to individuals who have a preexisting condition and have been uninsured for at least six months until 2014.

• All insurance policies must offer dependent coverage to children who have not yet attained age 27.

• Insurance companies must cover certain preventive services. They also can no longer impose lifetime coverage limits, rescind coverage for any reason other than fraud, or exclude preexisting conditions for children.

• Businesses with less than 25 full-time workers who are paid less than $50,000 per year in salary get a tax credit of up to 35% of the health insurance premiums paid for employees. The credit rises to 50% in 2014.

2011

• The costs for over-the-counter drugs not prescribed by a doctor can no longer be reimbursed through a health reimbursement account (HRA) or health flexible spending account (FSA) or be reimbursed on a tax-free basis through a health savings account (HSA) or Archer Medical Savings Account (MSA).

• The tax on distributions from a HSA or an Archer MSA that are not used for qualified medical expenses is increased to 20% of the disbursed amount, up from 10% for HSAs and 15% for Archer MSAs.

• Medicare recipients receive free preventive services and a 50% discount on brand name drugs purchased in the Part D doughnut hole.

2013

• Starting in 2013, single individuals with earned income in excess of $200,000 and married couples with earned income in excess of $250,000 will pay an additional 0.9% Medicare tax on the excess over those base amounts.

• A 3.8% Medicare tax will be imposed on net investment income of single individuals with adjusted gross income over $200,000 and joint filers over $250,000. Net investment income includes interest, dividends, royalties, rents, gross income from a trade or business involving passive activities, and the net gain from the disposition of property (other than property held in a trade or business). This tax applies only to income in excess of the thresholds. Thus, if a couple earns $150,000 in wages and $150,000 in capital gains, $50,000 will be subject to the new tax.

• The threshold for deducting medical expenses on a tax return increases from 7.5% to 10% of AGI. Individuals age 65 and older are exempt from this increase through 2016.

• Allowable flexible spending account contributions are limited to $2,500 per year. The dollar amount will be indexed for inflation after 2013.

2014

• All U.S. citizens and legal residents must have qualifying health insurance or pay a tax penalty. The tax penalty will be the greater of:

-- $95 per year (maximum of three times that amount or $285 per family) or 1% of taxable income in 2014

-- $325 per year (maximum of three times that amount or $975 per family) or 2% of taxable income in 2015

-- $695 per year (maximum of three times that amount or $2,085 per family) or 2.5% of income in 2016

After 2016, the penalty will be increased annually by a cost-of-living adjustment. Exemptions will be granted for financial hardship, religious objections, American Indians, individuals without coverage for less than three months, aliens not lawfully in the United States, incarcerated individuals, individuals who find the lowest cost plan option exceeds 8% of household income, individuals with incomes below the tax filing threshold ($9,350 for singles and $18,700 for couples in 2010), and individuals residing outside the U.S.

• Individuals and small businesses with fewer than 100 workers will be able to purchase health insurance on state-based health insurance exchanges. When insurance is purchased on the exchange, the individual reports his/her income. Low- and middle-income individuals and families may then be eligible for a tax credit based on the income reported. The IRS will pay the premium assistance credit directly to the insurance plan, with the individual paying the difference in premium. The premium assistance credit is available for individuals and families with incomes up to 400% of the federal poverty level ($43,320 for an individual or $88,200 for a family of four, based on 2009 poverty levels) who are not eligible for Medicaid, employer-sponsored insurance, or other coverage.

• Businesses with 50 or more workers will pay an annual penalty if they do not provide health insurance coverage to workers.

2018

• "Cadillac" health insurance plans must pay a 40% tax on the portion of coverage worth more than $10,200 for individuals and $27,500 for families.