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HSA Plans Can Offer No-Deductible Blood Pressure Monitors: IRS

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The Internal Revenue Services is trying to make health savings accounts (HSAs) easier, and cheaper, for people with high blood pressure, high cholesterol and other chronic conditions  to use.

The IRS today added many products and services aimed at people with chronic conditions to the package of preventive care benefits that an HSA-compatible high-deductible health plan, or HDHP, can offer without actually imposing the high deductible.

(Related: Insurers Give Congress 3 Ideas for Making HSAs Work Better)

The IRS has included the changes in the HDHP preventive care package list in IRS Notice 2019-45.

The notice took effect today.

HSA Deductibles

Congress developed the HSA to give people a tax break on saving money to pay for routine health care expenses.

A taxpayer must combine an HSA with high-deductible plan that meets IRS eligibility criteria.

For 2019, the minimum deductible for an HSA-compatible plan is $1,350 for individuals and $2,700 for families.

The maximum out-of-pocket expense limit is $6,750 for individuals and $13,500 for families.

The IRS imposes the deductible requirements to reduce the impact of the HSA program on the federal budget, and to give HSA users “skin in the game,” or some direct exposure to the actual cost of health care.

Health insurers, patient groups, health care provider groups have long argued that the federal government should find a way to allow HSA-compatible plans to cover some high-value types of care, such as drugs for high blood pressure, with a low deductible, or no deductible, to reduce the odds that HSA users will skimp on types of care that could protect them from strokes, heart attacks and other health care catastrophes.

Preventive Care List Additions

Here are the products and services the IRS added to the preventive care package for HSA-compatible HDHPs:


  • Peak flow meter.
  • Inhaled corticosteroids.

Congestive heart failure or coronary artery disease:

  • ACE inhibitors.
  • Beta blockers.


  • Selective serotonin reuptake inhibitors.


  • Insulin and other glucose lowering agents.
  • Retinopathy screening.
  • Glucometer.
  • Hemoglobin A1c testing.
  • Statins.

Heart disease:

  • Low-density lipoprotein testing
  • Statins.

High blood pressure: 

  • Blood pressure monitor.

Liver disease:

  • International normalized ratio testing.


  • Anti-resorptive therapy.

What IRS Notice 2019-45 Does Not Do

Kim Buckey, vice president of client services at DirectPath, a benefits plan services provider, said in a written commentary that the new notices apply only to the preventive care package for HSA-compatible health plans.

The new notice has no effect on the Affordable Care Act preventive care package, Buckey says.

The ACA preventive care package rules require major medical plans to cover some products and services, such as annual checkups, without imposing deductibles or other cost-sharing requirements on the patients.

The products and services included in the new HSA-compatible plan notice are not general preventive care items, Buckey says.

“These medications are only applicable to individuals with specific health conditions,” Buckey says.


A copy of IRS Notice 2019-45 is available here.

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