1.)  Patient Protection and Affordable Care Act. A whole host of changes will occur. Here are some: Increase Medicare payroll tax by 0.9 percent on high-income earners • Impose a 3.8 percent tax on net investment income of high-income individuals • $500,000 cap on health insurers' deduction for executive compensation • Eliminate employer deduction for Medicare Part D subsidy • FSA limitations to $2500 per year • Excise tax on medical device manufacturers and importers • Medical expense deduction floor increases to 10 percent • Nationwide bundled payment pilot begins in Medicare • Increased Medicaid reimbursement for primary care • Medicare physician comparison data available to the public • Reductions in Medicare payments for select hospital readmissions • Expanded coverage of preventive services by Medicaid

2.)  Mobile apps. More and more health care is moving to hand held sets for phone or other PDA use. The techs and the government are calling for this, and so is the marketplace. Individuals are substantially savvier now than even just a couple of years ago when it comes to searching for information on their phone. According to PCMag.com, a just released study by Nielsen showed that 50.4 percent of all mobile subscribers owned a smart phone. With the advantage of smart phone technology and data packages offered by all the major wireless carriers, most people with a health plan and a cell phone can find out where their closest doctor is located, and even find out information about available medical services. Columbus CEO Magazine reports that "approximately 500 million smart phone users worldwide will use a health care app by 2015, according to mobile research specialists Research2Guidance."

3.)   Health exchanges. "Beginning with an open enrollment period in 2013, exchanges will help individuals and small employers shop for, select, and enroll in high-quality, affordable private health plans that fit their needs at competitive prices.  Exchanges will assist eligible individuals to receive premium tax credits or coverage through other Federal or State health care programs.  By providing one-stop shopping, exchanges will make purchasing health insurance easier and more understandable'" according to Healthcare.gov, a federal government website managed by the US Department of Health and Human Services.

But states who are balking at setting them up are going to have a rude awakening when the federal exchange goes live, "humming along largely under the radar on a tight development schedule overseen by the HHS," according to the Washington Post. "Eventually more than 25 million people are expected to get coverage through exchanges, including many who were previously uninsured.  HHS contractors are working feverishly to design and test computer systems that would make the federal exchange come alive. It's a top priority for the administration, which is guarding the details closely." And, only 14 states and Washington, D.C., have adopted their own plans for their exchanges. "Meanwhile, the federal exchange is advancing."

4.) Dental.  With the exception of pediatric Medicaid, individual and small group dental plans are going to be an even hotter ticket than standing room only at the final game of the World Series. Realizing that the PPACA left this benefit off the table for adults, and that about half the country has no dental coverage, the rush to fill the gap is coming. The National Association of Dental Plans recommends getting in front of the curve by offering various types of affordable dental plans. Since most people have this type of product on a voluntary basis, and typically through their employer, it makes sense to promote it to the masses on an individual plan design that is price sensitive and competitive in the market—indemnity, discount, or PPO. And, take away the problems associated with dental—like waiting periods and annual maximums. 

5.) Less doctors, longer waits. Since Massachusetts put their state health care program in place, the wait time to see a physician is now about 50 days—the longest in the nation. According to MedicalDaily.com, "many physicians' offices are turning away patients covered by Medicaid, which is a third of the health care expansion covered by the Affordable Care Act. It is an invisible problem, experts admit. Patients still get seen, but their doctor visits are accompanied by a longer wait time and less time with their physicians. As a result, some say that people are driving increased distances to get care and over-reliance on emergency room visits (which come with their own notorious lengthy wait times)."

Health care in 2013 and beyond may be more challenging than ever, but the opportunities for niche players and stakeholders in general are becoming greater. If you are in wellness, IT, voluntary benefits, medical care clinics, limited medical indemnity health insurance, mental health counseling (including PTSD), diabetes management, or other ancillary services, you can position yourself to take advantage of the impending cyclone of millions of individuals, families, and businesses who are looking now for products that are affordable, save money on expenses, and can be very portable. Plus, the vast majority of non-medical services are off the table with PPACA. It makes sense to gaze into the future, even if you can only get just a glimpse of what to expect. Don't wait too long. The future is almost here.