In a win for the health savings account industry and consumers with certain chronic illnesses, the Trump Treasury Department has broadened the list of preventative care items that may be covered at 100% under a high-deductible health plan before the deductible kicks in. But whether insurers will absorb the new costs or pass them on to employers and consumers in premium increases is a big unknown.
Notice 2019-45, Additional Preventative Care Benefits Permitted to be Provided by a High Deductible Health Plan, is effective immediately. That’s important because now is when health insurance companies and employers are setting up plans together for the 2020 plan year.
The thinking is that more employers will move toward high-deductible health insurance plans, with accompanying health savings accounts—and more employees will choose them–if these plans cover more preventative services before the deductible. Before, if a plan included these preventative services, it wouldn’t be an HSA-eligible plan.
“It’s opening up HSAs to more people, on the face of it; that’s what we would expect,” says Shobin Uralil, cofounder of health savings account provider Lively. By opening and contributing to an HSA, consumers can pay for immediate or future health care expenses with big tax savings.
The notice “does not expand the scope of preventive care beyond the list.” So if you’re thinking, well, if SSRIs are covered, SNRIs should be covered, too–tough luck. And the notice makes clear that prior notices on preventative care are still in force (vasectomies are not preventative; that’s Notice 2018-12). Also, note that the services/meds must be prescribed in relation to a specific diagnosis. Here’s the list:
| 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 Treasury and the IRS, in consultation with HHS, will review the list every five to ten years to make additions or deletions.
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