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Preventive Care High Deductible Health Plan Exceptions Expanded for Chronic Conditions


Tracy Tasch

Preventive Care High Deductible Health Plan Exceptions Expanded for Chronic Conditions

Effective July 17, 2019, the list of preventive care benefits that can be provided by a high deductible health plan (HDHP) without a deductible or with a deductible below the applicable minimum deductible is expanded. The list now includes certain cost effective medical care services and prescription drugs for certain chronic conditions.

HDHPs and Health Savings Accounts

Individuals covered by an HDHP generally may establish and deduct contributions to a Health Savings Account (HSA). To qualify as an HDHP, a plan may not provide benefits for any year until the minimum deductible for that year is satisfied. However, an HDHP is not required to have a deductible for preventive care.

Current Rule for Chronic Conditions

Under the existing rule, preventive care generally does not include any service or benefit intended to treat an existing illness, injury, or condition. As a result, the cost barriers for care have resulted in some individuals diagnosed with certain chronic conditions failing to get effective and necessary care that would prevent making the chronic condition worse. Failure to address chronic conditions can lead to amputation, blindness, heart attacks, and strokes that require considerably more extensive medical intervention.

Treatments for Chronic Care as Preventive Care

The following medical care services are now classified as preventive care for someone with that chronic condition:

  • angiotensin converting enzyme (ACE) inhibitors for individuals diagnosed with congestive heart failure, diabetes, or coronary artery disease;
  • anti-resorptive therapy for individuals diagnosed with osteoporosis or osteopenia;
  • blood pressure monitor for individuals diagnosed with hypertension;
  • peak flow meter for individuals diagnosed with asthma;
  • inhaled corticosteroids for individuals diagnosed with asthma;
  • glucometer for individuals diagnosed with diabetes;
  • hemoglobin A1c testing for individuals diagnosed with diabetes;
  • insulin and other glucose lowering agents for individuals diagnosed with diabetes;
  • retinopathy screening for individuals diagnosed with diabetes; and
  • statins for individuals diagnosed with heart disease and/or diabetes.