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IRS expands preventive care benefits that are not subject to HDHPs’ deductible
By Heather Mehta on July 19, 2019 at 12:30 PM EDT

Blood pressure monitorCertain treatments for chronic conditions can now be covered by high deductible health plans (HDHPs) as preventive care before the deductible is met. Pursuant to an executive order, a new IRS notice will allow individuals with certain conditions, such as asthma or diabetes, to obtain coverage for treatments and medications, such as inhalers and insulin, without first meeting their high deductible.

HDHPs require covered individuals to pay all medical costs, except for preventive care, until the deductible is met. An individual must be covered by a HDHP and have no disqualifying health coverage to be eligible to use a health savings account.

In IRS Notice 2019-45, which was effective July 17, 2019, the Treasury Department and the Internal Revenue Service expanded the preventive care HDHPs may cover to include certain treatments for chronic illnesses. The IRS and Treasury used the following criteria to determine whether a treatment was preventive care:

  • the medical service or item is low-cost;
  • there is medical evidence supporting high cost efficiency of preventing exacerbation of the chronic condition or the development of a secondary condition; and
  • there is a strong likelihood, documented by clinical evidence, that with respect to the class of individuals prescribed the item or service, the specific service or use of the item will prevent the exacerbation of the chronic condition or the development of a secondary condition that requires significantly higher cost treatments.

The appendix to the notice lists the following approved preventive care treatments:

Preventive care for specified conditions

For individuals diagnosed with

Angiotensin Converting Enzyme (ACE) inhibitors

Congestive heart failure, diabetes, and/or coronary artery disease

Anti-resorptive therapy

Osteoporosis and/or osteopenia

Beta-blockers

Congestive heart failure and/or coronary artery disease

Blood pressure monitor

Hypertension

Inhaled corticosteroids

Asthma

Insulin and other glucose-lowering agents

Diabetes

Retinopathy screening

Diabetes

Peak flow meter

Asthma

Glucometer

Diabetes

Hemoglobin A1c testing

Diabetes

International Normalized Ratio (INR) testing

Liver disease and/or bleeding disorders

Low-density Lipoprotein (LDL) testing

Heart disease

Selective Serotonin Reuptake Inhibitors (SSRIs)

Depression

Statins

Heart disease and/or diabetes

The notice does not mandate that HDHPs cover the treatments as preventive care. Sponsors of HDHPs can choose whether they want to classify the treatments as preventive care that can be covered prior to an individual meeting his or her deductible.

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