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The IRS traditionally has allowed patients to deduct medical expenses once outlays reached 7.5 percent of income. That share jumps to 10 percent after Jan. 1. Federal officials estimate the rule will yield an additional $15 billion in revenue through 2019.

White said she doesn't expect the new threshold to affect a lot of people. Groups that could feel it the most include seniors and the seriously ill.

Though new taxes and caps on deductions start Jan. 1, you will have to wait until the fall to take advantage of a new insurance plan debuting on the local market.

HOSPITALITY HEALTH CO-OP

Beginning in October, Las Vegans will be able to enroll in the Hospitality Health CO-OP, or consumer operated and oriented plan.

The CO-OP is working now on meeting state requirements for insurers. State health officials just approved its network's adequacy, and it should have its certification of authority as an insurance agency in January, said Bobbette Bond, the CO-OP's project coordinator.

The group must be ready to accept members in October, so it can begin offering coverage on Jan. 1, 2014, in time to participate in the state's insurance exchange.

Bond said the CO-OP will be able to accept 30,000 members in its first year.

The Culinary Health Fund is co-sponsoring the CO-OP, along with its national parent, UNITE HERE Health, and the Health Services Coalition, a local consumer advocacy group that negotiates health care costs and tracks quality of care for more than 300,000 union members.

But you won't have to be a union member to take advantage of the CO-OP. Bond said the group will target individuals and small- business owners who want an alternative to large, corporate insurers based out of state.

"We really think it's going to be an attractive option for anyone who's not happy with their commercial insurance, or anyone who's attracted to the idea of nonprofit health-care coverage," Bond said. "It will appeal to anybody who's interested in the whole concept of community first and Nevada first, and who wants to keep resources in Nevada, as opposed to buying coverage from commercial insurers whose profits go out of state. We think that's really one of our most differentiating qualities."

Plus, unlike traditional insurance, the CO-OP's members will have some say in the direction of its programs and coverage. More than half of its board must be members or customers, and directors will have to be elected by a majority vote.

Also unusual will be the simplicity of its health plans, Bond said.

"We're really focusing on that. How simple can we stay and still be in compliance with exchange regulations?"

And the CO-OP will have patient advocates who guide members through the health system from the moment they enter it. For example, diabetic patients will receive guidance and follow-up to make sure they get preventive care and keep up with their specialist visits, medications and blood-glucose monitoring.

It's too early to quote premiums, Bond said, but she said the CO- OP expects to offer competitive coverage rates.

More importantly, she said, the CO-OP will give locals new power over their health coverage.

"It's a big deal for small businesses to have the opportunity to participate in the local economy in this way," Bond said.