The IRS has issued guidance expanding the preventive care benefits that can be provided by an HSA-qualified High Deductible Health Plan (HDHP) prior to the deductible being met. The full IRS release can be found here and a table of services is listed below.
As background, an HSA-qualified HDHP may only cover services prior to the deductible being met if those services are deemed preventive. Under the prior Health Savings Account (HSA) rules, preventive care generally did not include services or benefits intended to treat existing illnesses or conditions. Policymakers have expressed concern that individuals with these conditions might not seek the necessary care to prevent their conditions from worsening due to the required cost-sharing under their HDHP coverage. This results in an exacerbation of manageable conditions and more extensive medical interventions.
The new guidance lists specific services and the chronic conditions they are intended to treat that are considered preventive care for HSA-qualified HDHPs. It is important to note that this expanded preventive coverage for HDHPs does not affect or replace the
preventive services that non-grandfathered plans are required to cover under PPACA. Employer sponsors of HDHPs should also be aware that the IRS guidance does not include other services that may meet the same criteria. Except as listed, services that treat complications or secondary conditions are also not treated as preventive care under the HSA rules.
This expansion of coverage is optional. Employer sponsors of HDHPs who wish to do so may implement changes to their plan design effective immediately. MedCost will partner with clients and their pharmacy benefit manager partners to coordinate administration of these services.
| Preventive Care for Special 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 |
If you have any questions, please contact your MedCost Account Manager or [email protected].