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IRS Expands List of Preventive Care Benefits Eligible for Coverage by High Deductible Health Plans

July 19, 2019

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PRESS CONTACTS
Mary Mullaney, Director, Hospital Payment Policies

The Internal Revenue Service (IRS) July 17 released a notice that expands the list of preventive care benefits permitted to be provided by a high deductible health plan (HDHP) without requiring the enrollee to meet the deductible. Specifically, items and medical services to treat certain chronic conditions (noted in the Appendix of the notice) will now be included in the list of preventive care benefits. Previously, preventive care benefits did not include medical services or benefits intended to treat an existing illness, injury, or condition.

The notice acknowledges that cost barriers have resulted in some individuals diagnosed with chronic conditions failing to seek or utilize effective and necessary care that would prevent exacerbation of the chronic condition. Failure to treat chronic conditions can lead to adverse consequences that require considerably more extensive medical intervention.

Therefore, the Treasury Department and the IRS have determined that certain medical care services and items purchases, including prescription drugs, for certain chronic conditions should be classified as preventive for someone with that chronic condition. Each medical service or item, when prescribed for an individual with the related chronic condition, should have the following characteristics:

  • 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.

The criteria apply to only those items and services listed in the Appendix. Items and services that meet (or may meet) the criteria but are not on the list are not treated as preventive care.

The notice is effective July 17, 2019.

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