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Health care reform's second anniversary: The 6 biggest changes so far Posted: March 25th, 2012

By Barbara Marquand

Health care reform continues to divide the country, but everyone can agree that the Patient Protection and Affordable Care Act has ushered in major changes.

President Obama signed the act into law March 23, 2010. Here's a look at some of the most significant provisions that have gone into effect since then.

1. Young adults under 26 can stay on their parents' health insurance plans

Before the law, health insurance companies could force adult children off their parents' medical insurance plans as early as age 19. Now adult kids can stay on their parents' plans until age 26. About 2.5 million more young adults now have health insurance because of the provision, which took effect in September 2010, according to the National Center for Health Statistics at the Centers for Disease Control and Prevention.

2. Preventive care is fully covered

All new health insurance plans must cover certain preventive services, such as colonoscopies, mammograms and well-child visits, without charging deductibles, co-pays or coinsurance. A controversial new rule also requires health plans to fully cover birth control.

3. The Medicare 'donut hole' is closing

Some Medicare drug plans have an annual coverage limit, which creates a gap known as the "donut hole." Once seniors reach the limit, they have to pay out of pocket for drugs. Starting last year, seniors who reached the coverage gap could receive a 50 percent discount on brand-name prescriptions covered by Medicare. The savings will grow each year until the gap is closed in 2020.

4. Kids' with pre-existing conditions qualify for coverage

Health insurance companies cannot deny coverage to children under 19 because of pre-existing conditions. The new rule went into effect September 2010.

5. Lifetime limits are banned

Insurers can no longer put lifetime dollar limits on essential benefits, like hospital stays.

6. Pre-Existing Condition Insurance Plan provides access to coverage

People who have been uninsured for at least six months because of a pre-existing condition can buy coverage through the Pre-Existing Condition Insurance Plan (PCIP), which is operated in every state.

More changes are on the way. Insurance exchanges, which will serve as marketplaces where individuals and small groups can buy health insurance coverage, open in 2014. That same year, the law will ban insurers from denying coverage or charging a higher premium to anyone based on the member's pre-existing condition. The individual mandate, which requires virtually everyone to have health insurance, is also scheduled to go into effect in 2014 -- unless the U.S. Supreme Court rules the mandate unconstitutional when it takes up the case this term.