Beginning January 1, 2014, all individuals must obtain minimum essential coverage or pay a penalty.  There are exceptions if the coverage is unaffordable (the lowest-cost option available costs more than 8% of the individual's household income), for low-income taxpayers, and for coverage gaps up to three months.

Federal premium assistance to purchase Exchange coverage is available for certain individuals with household income up to 400% of the Federal Poverty Level.

Employers with 25 or fewer full-time equivalent employees who earn $50,000 or less on average may earn a tax credit if the employer provides health coverage and pays at least 50% of the premium cost.

Beginning January 1, 2014, an employer with 50 or more full-time equivalent employees that does not offer full-time employees health coverage, or offers coverage that is either unaffordable or inadequate, will owe a Free Rider Penalty if at least one employee receives a premium tax credit to purchase Exchange coverage.

The Free Choice Voucher provision was repealed as part of Department of Defense and Full-Year Continuing Appropriations Act, 2011.

Beginning January 1, 2018, a 40% nondeductible excise tax will be imposed the extent the aggregate value of specified employer-sponsored health coverage exceeds certain threshold amounts.

Plan sponsors of self-funded plans and insurers of insured plans must pay a fee to help fund federal comparative effectiveness research based on the average number of covered lives.  The fee is $1 per individual for the first plan year ending after September 30, 2012, and $2 for each subsequent year, continuing to increase until expiring after 2019.

For three years beginning in 2014, health insurance issuers and third party administrators on behalf of non-grandfathered group health plans will be required to pay reinsurance fees to state-established Exchange reinsurance entities.

Health Care Reform imposes new fees on brand name prescription drug manufacturers, medical device manufactures, and health insurance companies, which could indirectly raise health plan costs for plan sponsors.

Employers that provide prescription drug coverage to Medicare-eligible retirees that is at least as valuable as the Medicare Part D benefit are eligible for a subsidy of 28% of allowable prescription drug claims. Beginning with the 2013 tax year, an employer's allowable deduction for retiree prescription drug expenses must be reduced by the amount of the tax-free subsidy payment received.