The IRS has expanded its list of preventive care benefits for high-deductible health plans. Services that must be covered at no cost to policyholders now include condoms and breast cancer screenings other than mammograms, among other items.
“Generally, the Internal Revenue Code allows employees to take tax deductions and receive reimbursement from an account-based medical plan for qualified medical care expenses,” according to a report from WTS. “Medical care is defined as the diagnosis, cure, mitigation, treatment or prevention of disease, or to affect any structure or function of the body. The IRS has provided guidance over the years on what expenses meet the definition of medical care,”
Two separate notices outline the changes:
- Notice 2024-71 updates previous guidance to include male condoms as medical care. This means taxpayers may be able to take an income tax deduction for amounts spent to purchase condoms for themselves, their spouses or their dependents. Additionally, the cost of condoms may be paid or reimbursed under account-based health plans such as health flexible spending accounts, health reimbursement arrangements or health savings accounts. However, if the expense is reimbursed, it no longer would be deductible
- Notice 2024-75 allows employers with HSA-qualified high-deductible health plans to cover over-the-counter oral contraceptives (including emergency contraceptives), male condoms, breast cancer screenings other than mammograms, continuous glucose monitors and certain insulin products before an individual meets the plan’s minimum annual deductible (self-only or family).
To qualify for establishing an HSA, eligible individuals must be covered under an HDHP and have no disqualifying health coverage. An HDHP may not provide benefits before certain required minimum deductibles and maximum out-of-pocket expenses are met, with the exception of preventive care. To be considered preventive care, benefits must be listed either in Section 1861 of the Social Security Act or in guidance from the Department of the Treasury and the IRS. Anything intended to treat an existing illness, injury or condition is not considered preventive care.
“Employers should ensure their third-party administrators are aware that the pre-deductible coverage of the preventive services added under Notice 2024-75 will not affect a participant’s HSA eligibility,” the report concluded. “Employer sponsors of health FSAs or HRAs choosing to reimburse the cost of male condoms as a medical expense should discuss this with their TPAs and update plan materials, including plan documents and summary plan descriptions.”