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Friday, 16 August 2019 10:18

IRS Expands List of Preventive Services for HDHPs

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Many employers are offering High Deductible Health Plans (HDHPs) to their workforce these days, and they sometimes express concern that members with chronic conditions may delay much-needed routine care because of the financial burden they experience while meeting their deductible.

Good news is on the horizon! On July 17, 2019, the IRS expanded the list of services considered preventive and therefore able to be covered by insurance before or at a reduced deductible.

The expansion of preventive services applies to individuals with certain chronic conditions, such as diabetes, hypertension, and coronary artery disease. These members often must see their doctor and/or have tests run several times a year, and previously this care under HDHP plans went towards the deductible, leaving the member to pay out-of-pocket for these condition-monitoring services. There are three aspects that the IRS and Treasury have referenced in determining what new services will be preventive. From Notice 2019-45: 

  • The service or item is low-cost;

  • There is medical evidence supporting high cost efficiency (a large expected impact) 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.

This new list does not affect the existing list of services that are considered preventive. Remember, this original list includes certain preventive medication for conditions like high blood pressure and diabetes. If you’re not already covering those under your High Deductible Health Plan, you may want to consider that change as well, if your carrier allows that change for your group size.

These measures not only allow for these services to be covered as first-dollar for HDHP members thereby limiting the immediate member cost burden, but may also help to ensure health improvement which can impact overall plan costs over time. Below is a list of the chronic conditions and the newly-approved preventive care benefits associated with that condition:

Preventive Care

Chronic Condition

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 / glucose lowering agents

Diabetes

Retinopathy screening

Diabetes

Peak flow meter

Asthma

Glucometer

Diabetes

Hemoglobin A1c testing

Diabetes

INR testing

Liver disease and/or bleeding disorders

LDL testing

Heart disease

SSRIs

Depression

Statins

Heart disease and/or diabetes


While this new rule was released on July 17, 2019, each carrier can choose when they want to implement the changes to preventive care. It’s likely that most will wait until a group is up for renewal to put the changes into effect.

Only time will tell how these new provisions might impact plan costs in the long run. It’s possible that there will be higher costs initially as individuals who may have put off these treatments in the past due to high costs will now leverage the insurance coverage to obtain care. The long-term effect could be that costs are driven down as individuals more actively manage their conditions and reducing the risk of it getting worse or developing a related secondary condition. Prevention tends to cost much less than avoiding treatment in these health situations.

If you have any questions regarding the new preventive benefits, please contact your Fall River Team today!

Read 313 times Last modified on Tuesday, 27 August 2019 10:42