Guidance adds preventive care items to high-deductible health plans

By Sally P. Schreiber, J.D.

The IRS on Wednesday issued Notice 2019-45 to add 14 new preventive care items to the list of benefits that may be reimbursed by high-deductible health plans (HDHPs) without meeting any deductible amount. An HDHP is a health plan that satisfies certain requirements for minimum deductibles and maximum out-of-pocket expenses. Generally, under Sec. 223(c)(2)(A), an HDHP may not provide benefits for any year until the minimum deductible for that year is satisfied.

Sec. 223(c)(2)(C) provides a safe harbor for the absence of a deductible for preventive care: “A plan shall not fail to be treated as a high deductible health plan by reason of failing to have a deductible for preventive care (within the meaning of section 1861 of the Social Security Act, except as otherwise provided by the Secretary).” Therefore, an HDHP may provide preventive care benefits without a deductible or, subject to any requirements under Section 2713 of the Public Health Service Act, with a deductible below the minimum annual deductible otherwise required by Sec. 223(c)(2)(A). To qualify as a preventive care benefit, the benefit must either be described as preventive care under Section 1861 of the Social Security Act or be determined to be preventive care in guidance issued by the IRS.

The IRS says it is aware that some individuals with chronic conditions fail to seek or make use of medical care that would prevent exacerbation of the chronic condition because of the high cost of such care and that failure to address these chronic conditions can lead to consequences, such as amputation, blindness, heart attacks, and strokes, that require considerably more extensive medical intervention. Accordingly, the IRS added the following items to qualify as preventive care for treating the corresponding health conditions:

  • Angiotensin converting enzyme (ACE) inhibitors for individuals diagnosed with congestive heart failure, diabetes, or coronary artery disease;
  • Anti-resorptive therapy for osteoporosis and/or osteopenia;
  • Beta blockers for congestive heart failure or coronary artery disease;
  • Blood pressure monitor for hypertension;
  • Inhaled corticosteroids for asthma;
  • Insulin and other glucose-lowering agents for diabetes;
  • Retinopathy screening for diabetes;
  • Peak flow meter for asthma;
  • Glucometer for diabetes;
  • Hemoglobin A1c testing for diabetes;
  • International normalized ratio (INR) testing for liver disease and/or bleeding disorders;
  • Low-density lipoprotein (LDL) testing for heart disease;
  • Selective serotonin reuptake inhibitors (SSRIs) for depression; and
  • Statins for heart disease and/or diabetes.

The notice is effective July 17, 2019.

— Sally Schreiber, J.D., ( is a Tax Adviser senior editor.

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