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HSA benefits for chronic conditions expanded by IRS

On Wednesday July 17th, the Internal Revenue Service (IRS) added care for a range of chronic conditions to the list of preventive care benefits that may be provided by a high deductible health plan (HDHP).

Notice 2019-45 (PDF), posted today on, lists the new types of medical care that may be treated as preventive care for this purpose.

Employees with high deductible health plans no longer have to pay off their deductible before insurance covers chronic disease medications. Now they can use their HSA dollars to pay for life saving treatments after new rules from the IRS and Treasury Department determined chronic disease medications qualify as preventive care under high deductible health plans. The guidance follows President Donald Trump's June 24 executive order that directed the U.S. Treasury Department to find ways to expand the use of health savings accounts paired with high-deductible health plans to pay for "medical care that helps maintain health status for individuals with chronic conditions."

The three federal agencies (Treasury, the IRS and the Department of Health and Human Services) will review and add or subtract from the list periodically, according to the notice.

When does it take effect?

Because the change is being issued as a guidance, it doesn’t require a formal rule-making process and could be incorporated into health plans being offered in 2020.


Preventive Care for Specified Conditions / Individuals Diagnosed with

  • Angiotensin Converting Enzyme (ACE) inhibitors / Congestive heart failure, diabetes, and/or coronary artery disease

  • Anti-resorptive therapy / Osteoporosis and/or osteopenia

  • Beta-blockers / Congestive heart failure and/or coronary artery disease

  • Blood pressure monitor / Hypertension

  • Inhaled corticosteroids / Asthma

  • Insulin and other glucose lowering agents / Diabetes

  • Retinopathy screening / Diabetes

  • Peak flow meter / Asthma

  • Glucometer / Diabetes

  • Hemoglobin Ac1 testing / Diabetes

  • International Normalized Ratio (INR) testing / Liver disease and/or bleeding disorders

  • Low-density Lipoprotein (LDL) testing / Heart disease

  • Selective Serotonin Reuptake Inhibitors (SSRIs) / Depression

  • Statins / Heart disease and/or diabetes

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