IRS Notice with HSA Implications Expands “Preventive” Care to Include Certain Chronic Conditions
August 27, 2019
The IRS has issued Notice 2019-45, in which it identifies certain chronic health conditions whose treatments will now be considered “preventive.” As a result, such treatments can be covered by a health insurance plan without first meeting the minimum deductibles generally required of high deductible health plans (HDHPs) for health savings account (HSA) contribution eligibility purposes. It is important to note that this is a list of what the IRS identifies as preventative, however health plans are not required to offer coverage.
This guidance, effective July 17, 2019, is a response to President Trump’s Executive Order issued on June 24, 2019. The President charged the Secretary of the Treasury with issuing guidance that would “expand the ability of patients to select HDHPs that can be used alongside an HSA, and that cover low-cost preventive care before the deductible, that helps maintain health status for individuals with chronic conditions.”
In general, preventive care does not include treatment for existing illnesses or conditions. Under current HDHP/HSA rules, treatments of a non-preventive nature that are covered or reimbursed by a health plan without first satisfying HDHP conditions would generally disqualify a covered individual from HSA contribution eligibility.
The new notice increases the number of services that can be covered pre-deductible by expanding the definition of preventive care. Previously, preventative care only applied to services that were not provided in response to a particular condition, such as annual physicals. Now, the IRS will consider treatments for certain chronic conditions to be preventive.
Notice 2019-45 identifies the following conditions whose ongoing treatment may now be considered preventive and, therefore, may be covered by a health plan without first satisfying an HSA-qualifying deductible:
|
Preventive Care for Specified Conditions |
For People 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 |
Items not listed in Notice 2019-45 will not be considered preventive for HDHP purposes at this time. Guidance is not currently available from the IRS for a timeframe for a health plan to adjust their plan documents to limit coverage to this list
According to the notice, services to be covered by an HDHP pre-deductible should be “low-cost” and demonstrate a high-impact. In addition, there must be strong evidence that the absence of the service will result in the condition worsening or the development of another serious medical issue.
This important new guidance will enable more Americans to better utilize their health savings accounts (HSAs), take more responsibility for their healthcare spending, and become better healthcare consumers.
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