Did you know that many preventive drugs are covered by the Patient Protection and Affordable Care Act (ACA)? The ACA regulated the coverage of many preventive services to make sure they are available under all benefit plans—including private health insurance. In addition, insurance providers often fully cover additional preventive services on some High Deductible Health Plans (HDHP) to encourage their members to stay healthy and keep their costs down. Collectively, these benefits are known as “preventive drug benefits”.
ACA Preventive Drugs
The ACA guarantees that preventive services are covered with no out-of-pocket expenses even before you have met your deductible. These preventive services include several medications:
- Routine immunization and vaccines (including an annual flu shot)
- Aspirin (when used to prevent cardiovascular disease for those at risk)
- Statins (when used to prevent cardiovascular disease for those at risk)
Importantly, this benefit does not apply to some plans that were grandfathered-in from before 2014 when the majority of the ACA went into effect. You should ask your Human Resources department if you are uncertain about the status of your plan.
HSA Preventive Drugs
On many HSA-qualifying health insurance plans, certain preventive drugs are exempt from the deductible. If your plan has an HSA preventive drug option, often called a “preventive drug rider”, you will usually have low or no cost for the following kinds of drugs:
- Asthma and COPD medication
- Breast Cancer medication
- Cardiovascular/heart disease drugs
- Diabetes medication
- Gastrointestinal/ulcer drugs
- High Cholesterol medication
- Smoking Cessation aids
This is a general list. Please check your plan’s formulary for more details about your particular coverage. A more detailed list of preventive drug benefits and regulations can be found at healthcare.gov.
Get the latest news and insights on increasing healthcare efficiencies delivered right to your inbox. Sign up for the MyHealthMath newsletter.