Group takes on Medicare rules to promote value-based plan designs
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A Washington-based employer benefits lobbying organization is seeking changes to the Medicare Prescription Drug, Improvement, and Modernization Act that would make it easier for companies to implement value-based insurance designs in high-deductible health care plans with health savings accounts.
Under current Internal Revenue Service rules, only preventive medications and health care services such as cancer screenings that have been identified as “preventive” by the U.S. Preventive Care Task Force are exempt from the deductibles in HSA-qualified high-deductible plans.
However, the act does not permit first-dollar coverage of medications and medical care services used to treat chronic conditions, even if they would prevent patients from getting worse.
The act’s safe harbor “is really narrowly drafted only to consist of primary preventive services,” said Katy Spangler, senior vice president of health policy at the Washington-based American Benefits Council. “Maybe you could broaden that or update that 10-year-old definition.”
In particular, benefits council members would like “a little more flexibility to offer some of these high-value services before their employees meet their deductibles … like certain prescription drugs that would hopefully be classified as preventive care under the safe harbor,” Ms. Spangler said.
In response to the council’s overtures, the IRS is “taking a look at expanding the definition for some high-value things,” she said. “There’s a legitimate question of how do you make sure that plans have the option to cover appropriate preventive services to manage chronic conditions, but at the same time not create such a big loophole that folks are offering everything under the sun.”
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