IRS Expands Preventive Care Allowed Under HDHPs

IRS Expands Preventive Care Allowed Under HDHPs

With the issuance of Notice 2019-45 on July 17, 2019, the Treasury Department and the Internal Revenue Service (IRS) expanded the types of preventative care covered under a High Deductible Health Plan (HDHP) for people with certain chronic conditions.

Under IRS code section 223(c)(2), HSA-qualified HDHPs cannot pay 100% of the cost for care received prior to the minimum deductible being met unless the care is classified as preventive. Created in 2005, Health Savings Accounts (HSAs) are available for individuals who are enrolled in a qualified HDHP and have no other, disqualifying health coverage.

Expanded Preventative Care Products and Services

Upon its issuance, Notice 2019-45 listed certain medical services and products, including prescriptions, used in the care of certain chronic conditions that may now be classified as preventive care under HDHP/HSA rules. These include:

Preventive Care Received or PurchasedFor 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
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

Any other medical care previously recognized as preventive care for purposes of HDHP/HSA rules is still treated as preventive care. In consultation with the department of Health and Human Services (HHS), Treasury and the IRS will review the full list every 5 to 10 years to make additions or deletions.

According to Plan Sponsor, in prior guidance preventive care generally did not include any service or benefit intended to treat an existing illness, injury, or condition. However, the agencies say they are aware that the cost for care has been an issue for some people. Due to affordability, some individuals fail to seek or use necessary care that would prevent worsening of their condition. Failing to get care for these chronic conditions has led to serious consequences, such as amputation, blindness, heart attacks and strokes. Often, the consequences require even more extensive and costly medical intervention.

Ruled Changed Due to Executive Order on Medical Price Transparency

This rule change is made pursuant to the Executive Order on medical price transparency signed by President Trump in June, 2019. Under the Executive Order, Treasury and the IRS were directed to consider ways to expand the use and flexibility of HSAs and HDHPs that cover low-cost preventive care. 

For more information, visit or contact your benefits administrator.

DataPath, Inc. creates technology solutions for the administration of Health Savings Accounts and other consumer directed healthcare benefits.

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