Diabetes, Deductibles & the IRS

People living with diabetes might soon have better access to care thanks to an unlikely source: the Internal Revenue Service.

According to the IRS, insurers may now treat the care of chronic conditions, like diabetes, as preventive care under the rules of high-deductible health plans.  In other words, people with diabetes could get insurance coverage for essentials like vision screening and insulin before meeting their annual insurance deductible.  The notice follows an executive order from President Donald Trump directing the IRS and the Treasury to consider how high deductible health plans might help “maintain health status” for people with chronic conditions.  

High-deductible health plans have a deductible of at least $1,350 for an individual or $2,700 for a family.  They are typically paired with a health savings account, to which patients can contribute with pre-tax dollars.  

Patients with these plans have historically had to meet their high deductible before insurance coverage kicks in.  The financial barrier can yield poor adherence, leading people with diabetes to ration insulin, delay physician appointments and skip medication doses.  The trend fared poorly for both patients and insurers. Poorly managed, chronic disease like diabetes can land patients in the emergency room or hospital.  That’s painful for patients – and expensive for their health plans.

Poorly managed chronic conditions can also lead to long-term complications that outweigh the risks and costs of the chronic conditions themselves.  The IRS statement acknowledged potential consequences like “amputation, blindness, heart attacks, and strokes,” which demand “considerably more extensive medical intervention.”

The IRS notice allows, but does not require, insurers to change their policies on high-deductible health plans.  But so far, patients and insurers alike have responded positively to the news.

Matt Eyles of America’s Health Insurance Plans commended the announcement, saying, “For the millions of Americans living with chronic health conditions, such as diabetes or hypertension, this new guidance improves access to affordable medications, treatment and medical equipment – all before patients must meet their deductible.”

Insurers could begin implementing the change in 2020 health plans.


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