If you have an HDHP, you may be working from the assumption that your insurance won’t cover anything before you meet your deductible. While the insurance company may wish that was the case, HDHPs are able to (and, in some cases, must) cover certain kinds of preventive care. These services can add up to hundreds or even thousands of dollars in essential services every year, so be sure to read the fine print on your plan before and after you choose it, and also to ask your company’s benefits administrator for these details if you can’t find them on your own.
Why are some services covered? Part of the reason is that when HDHPs were approved, the creators wanted to ensure that people weren’t forgoing important services like regular checkups and disease/condition screenings — not totally altruistically, as the longer some conditions go untreated, the more expensive they become for individuals and health insurance companies alike.
The other part is mostly the ACA, which further codified certain “essential health benefits” that must be covered as they are so essential to both personal and public health.
What are the services? Here, directly from the IRS:
An HDHP may provide preventive care benefits without a deductible or with a deductible less than the minimum annual deductible. Preventive care includes, but isn’t limited to, the following.
- Periodic health evaluations, including tests and diagnostic procedures ordered in connection with routine examinations, such as annual physicals.
- Routine prenatal and well-child care.
- Child and adult immunizations.
- Tobacco cessation programs.
- Obesity weight-loss programs.
- Screening services. This includes screening services for the following:
- Heart and vascular diseases.
- Infectious diseases.
- Mental health conditions.
- Substance abuse.
- Metabolic, nutritional, and endocrine conditions.
- Musculoskeletal disorders.
- Obstetric and gynecological conditions.
- Pediatric conditions.
- Vision and hearing disorders.For more information on screening services, see Notice 2004-23, 2004-15 I.R.B. 725 available at IRS.gov/irb/2004-15_IRB/ar10.html.
So before you pull out your wallet or HSA debit card to pay for a service, pull out your insurance card and see if that will cover it first.Like