HSA and Preventive Care

The IRS has loosened the rules on Health Savings Accounts (HSA) to allow greater distribution flexibility. Qualified High Deductible Health Plans (QHDHP) must apply all medical and prescription services towards the deductible, other than those considered ‘preventative.’ What was considered preventative was loosely defined in IRS Publication 969.  It includes child and adult annual physicals, annual OB-GYN, immunizations (get them, they protect us all!), screening services (i.e., cancer, heart disease, substance abuse, mental health conditions, etc.), tobacco cessation, and obesity weight-loss programs. 

Now, with Notice 2019-45, the IRS is allowing additional procedures, testing and prescriptions to be covered prior to the deductible being met. These only qualify if the enrollee has been diagnosed with certain specific conditions which are listed in the notice. Highlights include Statins, Beta-Blockers, ACE inhibitors and LDL testing for those with heart conditions. Insulin, glucometers, screening and testing for Diabetes related conditions and SSRIs for depression. 

While we see this as a positive step to making healthcare and insurance more affordable, it’s also going to take time to implement. Health insurance carriers need to update their plan designs, program their systems and train their staff. Doctors, hospitals and pharmacies also need to understand the changes. 

Lastly patients need to know what is covered more in depth so they can advocate for themselves and better research insurance options. QHDHP are considered Consumer Driven Health Plans (CDHP) with the covered individual acting in the consumer role. More so than ever consumers need to understand their insurance coverage and talk with their providers about what is being prescribed or recommended and how those work with their benefit plan. 

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