• Much was made of the size and complexity of the Patient Protection and Affordable Care Act when President Obama signed it into law in 2010. But now that the Supreme Court has upheld much of the act's constitutionality, it's a good time to review key provisions that have already gone live and to plot out what's expected to happen in the next two years.
• Changes already in place include:
• • Children under 19 cannot be denied coverage because of preexisting conditions.
• • Adult children may remain on parents' medical plan until they turn 26.
• • Lifetime insurance maximum payouts were eliminated. In addition, annual coverage limits are being phased out. Effective September 23, 2012, the annual limit increases to $2 million.
• • All new plans now must provide certain preventive services for free, such as mammograms, immunizations and colonoscopies.
• • People who've been refused insurance because of preexisting conditions may now be eligible for coverage through a "high-risk pool" program. Go to https://www.pcip.gov/ for information and to apply online.
• • Medicare Part D participants who reach the infamous doughnut hole now receive a 50 percent discount on brand-name prescription drugs - 14 percent on generics. (These discounts will gradually increase until 2020 when the doughnut hole will disappear.)
• Many core features of the Affordable Care Act won't take full effect until 2014 and details are still being finalized, but here are highlights of what's expected to happen between now and then:
• • By August 1, 2012, insurance companies that didn't spend at least 85 percent of 2011 premium dollars for large group plans (over 50 employees) on medical care must refund the difference, through refund checks or discounted future premiums

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