Financial advisors may understandably feel that they need scorecards to keep track of the changes required by health-care reform that could affect their clients. It's true that the most far-reaching of the new law's rules do not go into effect until 2014. That's when individuals will be mandated to obtain health insurance or pay penalties, and when insurers will no longer be able to deny coverage to people with pre-existing conditions or to charge them higher premiums.

But 77 rules either have already been implemented or will be before 2014, according to the Kaiser Family Foundation's Health Reform timeline. Most of these are the responsibilities of insurance companies and government agencies. In late September, for instance, insurers were required to begin providing dependent coverage for adult children until they turn 26 and were prohibited from placing a cap on lifetime benefits.

Similarly, Medicare will soon implement several health-care reform changes that will affect most retirees. In 2011, preventive tests will be fully covered with no cost sharing, and brand-name drugs will be discounted by 50% for those who reach the Part D coverage gap known as the doughnut hole. Also, retirees earning more than $85,000 a year ($170,000 for couples) will pay higher Part D premiums for the first time.

While financial advisors should be aware of these and other changes, their clients are not responsible for making them happen. But there are several health-care provisions that individuals and small businesses must act on before 2014. Listed below, they include programs and subsidies that individuals and small businesses may apply for or new tax rules that they must comply with.

2010
Individuals: Pre-existing condition insurance plan (PCIP). People who have been without insurance for six months or longer may qualify for this coverage. With $5 billion in federal subsidies, PCIP policies are expected to be the lowest-cost alternatives for those who are eligible. To qualify, individuals must provide proof (such as a letter) that they have been denied coverage because of pre-existing conditions. Even if they have been offered insurance, they are considered denied if the policy won't cover their pre-existing conditions.

PCIP plans are available in all 50 states and their benefits are federally mandated-out-of-pocket limits, for instance, cannot be more than those for health savings accounts. And premiums are to be the same as they would be for a standard population, with adjustments for age limited to four times the rate for the youngest policyholders.

In addition to the PCIP plans created by health-care reform, 34 states have their own high-risk pool plans. These state plans, most of which have been in existence for several years, will continue to operate alongside the PCIP plans. The rules for these state-sponsored plans vary widely-many, for example, do not require the individual to have been uninsured for six months.  In 2014, policyholders in both PCIPs and the state-sponsored plans will be transitioned to coverage through the state-based exchanges. Information about PCIP benefits and premiums in different states is available at www.healthcare.gov/law/provisions/preexisting.

Small Businesses: Tax credits. Health-care reform takes several steps to encourage small businesses to offer health insurance to their workers. Probably the most important of these is a tax credit that starts with the 2010 tax year and that may be available to companies with fewer than 25 full-time workers. Among the criteria: The average wage for all company employees must be less than $50,000, and the employer must pay at least one-half of the workers' premiums.

The amount of the tax credit is based on a sliding scale: Firms with fewer than 10 employees and an average wage under $25,000 will get the maximum credit, which equals 35% of the employer's contribution to workers' premiums. And in 2014, this top bracket will increase to 50%. For companies with more than 10 (but fewer than 25) employees, the size of the credit is smaller, and in some cases is zero. Finally, businesses can use this credit for no more than six years (and can use the 50% credit for only two years).

Early retiree reinsurance program. Since its start in June, more than 2,000 companies have been approved for this program, which subsidizes employers' coverage for retirees ages 55-64 who are not eligible for Medicare. Although businesses of all sizes can apply, it's expected that mostly small businesses will participate because relatively few of them offer health coverage to early retirees.

Under the rules, the government will reimburse businesses for 80% of retiree claims that fall between $15,000 and $90,000. Employers can then use that money to reduce premiums and other health-care costs. The program is scheduled to last until 2014, but many believe that its $5 billion funding will be exhausted within two years. A list of the companies that have so far been approved is available at www.healthcare.gov/law/provisions/retirement/index.html.

2011
Individuals: Health savings accounts, health reimbursement accounts and flexible spending accounts. Health-care reform made two short-term tweaks to these tax-advantaged health accounts, both of which become effective in 2011. First, money from HSAs, HRAs and FSAs can no longer be used to buy over-the-counter drugs unless they are prescribed by a physician.
The other change applies only to health savings accounts, where the penalty for using HSA funds for non-medical expenses before age 65 will double from 10% to 20% (for Archer Medical Savings Accounts, the penalty goes from 15% to 20%). The 2011 amounts for HSA contributions, minimum deductibles and maximum out-of-pocket limits are the same as in 2010.

Small Businesses: W-2 reporting. Beginning with the 2011 tax year, employers will be required to show on Form W-2 the total cost of employer-provided health insurance. Initially this provision is for information only. Then in 2018 insurers will pay an excise tax on so-called Cadillac plans-those whose total cost as shown on the W-2 exceeds a certain threshold. The tax will apply only to the portion of the cost that exceeds the threshold.

SIMPLE cafeteria safe harbor. Companies with fewer than 100 employees may take advantage of a health-care reform provision that allows them to establish cafeteria (Section 125) plans for workers without complying with Section 125's strict nondiscrimination rules. The new law does this by establishing a safe harbor with rules that are easier to comply with and that reduce administrative costs; moreover, companies can use the safe harbor until their number of employees reaches 200.

Wellness grants. Companies with fewer than 100 employees can qualify for $200 million in grants over a five-year period if they start wellness programs. To be eligible, businesses cannot have had wellness programs in existence as of March 23, 2010 (the date that the health-care reform act was signed into law), but can apply for funds if they started (or will start) such programs after that date. The grants are to be focused on specific needs-nutrition, smoking cessation, physical fitness and stress management.

2012
Individuals: Community Living Assistance Services and Support (CLASS) program. A federal long-term care insurance program, CLASS is scheduled to begin late in 2012. Once it is implemented, CLASS will enable employees and their non-working spouses to make voluntary premium payments through payroll deductions or direct contributions. Although it will be administered by the Department of Health and Human Services, CLASS will not receive government subsidies.

Individuals must be employed to be eligible for CLASS, but they can continue to make premium payments after they've quit working. The average monthly premium is expected to be about $160, with younger workers paying lower amounts. If their employer does not process payroll deductions, workers can make direct payments.

CLASS policyholders become eligible for benefit payments when they need help with the activities of daily living or have cognitive impairment. Moreover, they may receive benefits either while living at home or in an institution. To qualify for benefits, people will need to have paid into the program for at least five years (and to have worked for three of those years).

The minimum benefit is $1,500 a month ($50 a day), with the exact amount determined by the severity of the impairment or disability. People can use the payments, which are not taxable and which are indexed for inflation, for a variety of non-medical expenses. As the dollar amounts indicate, CLASS is not designed to be comprehensive long-term care insurance, but to provide some support for people needing assistance. One of its appealing features is that, unlike most long-term care insurance policies, benefit payments will continue as long as the policyholder lives.

Small Businesses: 1099 reporting rules. All businesses will have to report to the IRS on Form 1099 any payments to suppliers that total more than $600 a year. While not directly related to health-care reform, this controversial requirement will help to pay for some of the new law's subsidies by generating $17 billion in added tax revenue over ten years, according to the Congressional Budget Office. The reason for the revenue increase is that vendors are more likely to pay taxes on income that is reported on 1099s, which include taxpayer identification numbers.

Because of the costly paperwork burden it will impose on small companies in particular, this provision has been widely criticized by business organizations and several economists. Two bills to amend this requirement were defeated in Congress in September-one of them narrowly-and many observers believe that this rule will be modified before 2012.

2013
Individuals: Revision of itemized deduction amount. Starting with the 2013 tax year, individuals will be able to deduct unreimbursed medical expenses to the extent that they exceed 10% of adjusted gross income. Currently the threshold is 7.5%. This increase will be postponed until 2017 for individuals who are 65 and older.

Medicare taxes on unearned income. High-income individuals will pay an added Medicare tax on unearned income starting in 2013. Capital gains, dividends, interest, annuities, royalties and rents are examples of income that will be subject to the new rule. The tax equals 3.8% of the lesser of the individual's net investment income or the amount by which the individual's modified adjusted gross income exceeds $200,000 ($250,000 for married couples filing jointly).

Individuals and Small Businesses: Flexible savings accounts. A $2,500 annual limit on contributions to FSA accounts goes into effect in 2013. Currently there are no legal limits on FSA contributions, although most employer plans impose limits in the $4,000 - $5,000 range. As a result of this change, many individuals and small businesses that have FSAs are expected to switch to health savings accounts and health reimbursement accounts, which have much higher limits, and to the high-deductible policies with which they must be paired.

Small Businesses: Increased Medicare withholding. Businesses will be required to withhold taxes for Medicare Part A at a higher rate for those who earn more than $200,000 annually ($250,000 for married couples filing jointly). At present the Medicare payroll tax is 2.9%, with the worker and the employer each paying 1.45%. Under the new rule, starting in 2013 high-income individuals will pay an added 0.9%-increasing their share of the tax to 2.35% of their wages.

David Armes, CFP, MBA, is founder of Dover Financial Planning, a fee-only financial planning firm based in Long Beach, Calif., that analyzes the costs and coverage of Medicare and other health insurance options.