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Lawmakers Propose HDHP Coverage for Chronic Disease Prevention

A proposed bill would allow high-deductible health plans (HDHPs) to cover the costs of chronic disease prevention services before patients meet their deductibles.

A new bill would allow HDHPs to cover chronic disease prevent before member deductibles

Source: Thinkstock

By Thomas Beaton

- A new bill introduced into the House and Senate would allow high-deductible health plans (HDHPs) to provide chronic disease prevention services before a patient meets his or her deductible, which could help to accelerate a growing HDHP market.

The bill, entitled “The Chronic Disease Management Act of 2018,” states that HDHPs should be allowed to provide pre-deductible preventive care as a way to lower care costs, improve member outcomes, and reduce financial barriers for members.

“Allowing health savings account-eligible high-deductible health plans to cover chronic disease prevention and treatment on a pre-deductible basis promotes the concept of Value-Based Insurance Design, which is an effective tool to improve the quality and reduce the cost of care for Americans with chronic diseases, with improved outcomes via increased medication adherence, reduced complications, and decreased emergency department visits,” the bill said.

The bill would effectively amend part of the IRS code that currently prohibits HDHPs paired with health savings accounts (HSAs) to provide pre-deductible preventive care even when individuals have disabling or life-threatening conditions, a high risk of hospitalization, or require specialized healthcare delivery.

If passed, the legislation could add value to an already growing HDHP market based on trends in the healthcare industry.

The Center for Value-Based Insurance at the University of Michigan said implementation of the bill would allow payers to leverage “high value health plans” (HVHPs) that offer premiums lower than PPO and HMO amounts.

The Center believes that HVHPs can help reduce aggregate healthcare spending because HVHP members would participate in cost-effective utilization that lowers the need for other costly healthcare services.

The Center defines an HVHP as a HDHP paired with HSAs that provides pre-deductible preventive care, which would become a viable health plan option with the passing of the bill.

HDHPs are already an extremely popular health plan option in the employer-sponsored insurance market and the new benefits would likely drive employee adoption.

Research conducted by BenefitFocus found that employees are enrolling in HDHPs at a higher rate and that employees are leveraging financial benefits such as HSAs that lower out-of-pocket expenses. The bill would further improve financial benefits for these employees if passed.

The bill already has garnered bipartisan support with sponsorship from a GOP senator, GOP representative, Democratic senator, and a Democratic representative and would address some of the disadvantages of HDHPs.


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