Within six months

The couple can keep their current benefits, but the plan can no longer set lifetime limits on coverage or drop them if they get sick.

2013

The couple will contribute more to the Medicare program from their payroll taxes, 2.35 percent instead of the current 1.45 percent, because they earn more than $250,000. They will also pay an additional 3.8 percent tax on their investment income.

Some tax breaks for medical costs will be reduced. Flexible spending accounts, which typically allow employees to shelter as much as $4,000 or $5,000 from taxes, will be reduced to $2,500, and they will not pay for over-the-counter drugs. They must spend more than 10 percent of their income on medical expenses before they can be deducted, up from the existing 7.5 percent threshold.

2014 and after

The couple’s plan might have to meet new coverage standards, if the insurer makes significant changes in benefits or cost-sharing.

In 2018, the most expensive insurance policies would be subject to a new tax, which means the couple could face higher costs or lower benefits.