Access to Preventive Care Eased for Some HDHPs

The Internal Revenue Service (IRS) has made it easier for people who have high-deductible health plans (HDHPs) with health savings accounts (HSAs) to get preventive care services to treat chronic diseases even if the insured hasn’t yet met the deductible.

In the past, the Treasury Department and the IRS generally did not allow any preventive care services or benefits to be used to treat an existing illness, injury or condition. Health agencies argued that many individuals with chronic conditions often failed to get treatment because of the high cost of care. As a result, the “cost” of not getting proper care often was amputation, blindness, heart attacks or strokes — all of which require considerably more extensive medical intervention and costs.

This year, in response to these concerns, President Donald Trump issued Executive Order 13877 — “Improving Price and Quality Transparency in American Healthcare to Put Patients First.” The order directs the Secretary of the Treasury to issue guidance expanding certain patients’ ability to get care for chronic conditions.

The Treasury Department and the IRS worked with the Department of Health and Human Services (HHS) and issued IRS Notice 2019-45. The notice allows certain medical care services, including prescription drugs, to be classified as preventive care for someone with certain chronic conditions. These services can be obtained by insured members who have an HDHP without a deductible or with a deductible below the applicable minimum deductible (self-only or family) for an HDHP.  

For a service to be classified as a chronic condition and needing preventive services, the service or item must be low-cost, and there must be medical evidence that the service prevents the chronic condition from getting worse or developing into a secondary condition.  

If you have any questions about how this might affect you or your employees, please contact us at info@aleragroup.com.