New Guidance Allows HDHPs to Expand Preventive Care Benefits for Chronic Conditions

Millions of Americans with high-deductible health plans (HDHPs) will be able to more easily access care for their chronic conditions as a result of guidance issued by the Internal Revenue Service (IRS) and the Department of Treasury, which will allow insurers to pay for chronic care treatment before a patient meets their deductible.

Currently, people in HDHPs with health savings accounts have to meet their deductible before their insurance will cover treatment for chronic diseases, including diabetes, arthritis, or hypertension. The guidance expands the list of preventive care benefits insurers can offer people without cost-sharing.

These preventive care packages now include:

• Angiotensin-converting enzyme inhibitors for congestive heart failure, diabetes, and/or coronary artery disease
• β-blockers for congestive heart failure and/or coronary artery disease
• Inhaled corticosteroids for asthma
• Insulin, glucose meters, and glycated hemoglobin testing for diabetes
• Selective statin reuptake inhibitors for depression
• Statins for heart disease and/or diabetes

Prior guidance has traditionally stated that preventive care generally does not include any service or benefit intended to treat an existing illness, injury, or condition.

“However, the Treasury Department and the IRS are aware that the cost barriers for care have resulted in some individuals who are diagnosed with certain chronic conditions failing to seek or utilize effective and necessary care that would prevent exacerbation of the chronic condition,” states the guidance. “Failure to address these chronic conditions has been demonstrated to lead to consequences, such as amputation, blindness, heart attacks, and strokes that require considerably more extensive medical intervention.”

The change came as a response to President Donald Trump’s June executive order to improve price and quality transparency. The executive order also resulted in the launch of 5 new payment models to transform kidney disease care.

The guidance, which promotes value-based insurance design (VBID), received praise from The American Journal of Managed Care^® co-Editor-in-Chief A. Mark Fendrick, MD, director of the V-BID Center at the University of Michigan, who said in a statement, “As more and more Americans are facing high deductibles, they are struggling to pay for their essential medical care. Our research has shown this policy has the potential to lower out-of-pocket costs, reduce federal health care spending, and ultimately improve the health of millions diagnosed with chronic medical conditions.”

Matt Eyles, president and chief executive officer of America’s Health Insurance Plans, also commented on the guidance and commended it for helping to ensure Americans have affordable coverage and high-quality care.

"For the millions of Americans living with chronic health conditions, such as diabetes or hypertension, this new guidance improves access to affordable medication, treatment and medical equipment—all before patients must meet their deductible,” he said in a statement. “With this new policy, insurance providers will be able to offer enhanced preventive care before facing any deductible costs to help patients better manage their chronic conditions and avoid serious complications.”