Relief from high medical costs for chronic illnesses

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If you have a High Deductible Health Plan (HDHP) you KNOW. If you don’t have a HDHP here’s a synopsis: Individual deductibles are at least $1,350 or $2,700 for a family and total yearly out-of-pocket expenses can’t be more than $6,700 for an individual or $13,500 for a family. Here’s the thing, out-of-pocket expenses include deductibles, copayments and coinsurance as long as you see an in-network provider. For 2020 the deductible amounts are increasing to $1,400 for individuals and $2,800 for families. 

If you have a HDHP and a specified chronic condition, last month your knight in shining armour came in the form of Notice 2019-45. The Treasury Department and IRS in consultation with Health and Human Services determined that certain medical services and items purchased for chronic conditions should be classified as preventive care. Typically, HDHPs cover services only after the deductible is met. However, they are not required to have a deductible for preventive care. This allows for HDHPs to cover preventive care services and prescriptions at a higher level without the HDHP plan deductible being met. Preventive care generally does not include any service or treatment for an existing illness, condition or injury.

Notice 2019-45 is in response to an executive order that the “Secretary of Treasury, to the extent consistent with law, issue guidance to expand the ability of patients to select HDHPs that can be used alongside a Healthcare Savings Account (HSA), and that cover low-cost preventive care, before the deductible, that helps maintain health status for individuals with chronic conditions.

Only the conditions and items that are listed qualify as preventive care. If you are diagnosed with more than one condition on the list then all conditions are covered as preventive care. However, if you are diagnosed with a condition not on the list it will not be covered as preventive care. 

This also does not mean that you will not have to pay for services. Notice 2019-45 became effective July 17, 2019. Contact your insurance company to determine your cost for preventive care visits or prescriptions. 

Preventive Care for Specified ConditionsFor Individuals Diagnosed with
Angiotensin Converting Enzyme (ACE) inhibitorsCongestive heart failure, diabetes, and/or coronary artery disease
Anti-resorptive therapyOsteoporosis and/or osteopenia
Beta-blockersCongestive heart failure and/or coronary artery disease
Blood pressure monitorHypertension
Inhaled corticosteroidsAsthma
Insulin and other glucose lowering agentsDiabetes
Retinopathy screeningDiabetes
Peak flow meterAsthma
Hemoglobin A1c testingDiabetes
International Normalized Ratio (INR) testingLiver disease and/or bleeding disorders
Low-density Lipoprotein (LDL) testingHeart disease
Selective Serotonin Reuptake Inhibitors (SSRIs)Depression
StatinsHeart disease and/or diabetes

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