Preventive Drug Benefits: Find out what types are covered

by | Sep 16, 2020 | Employee Resources, Plan Basics

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)
  • Contraception

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.

Religious Exemption

Some “religious employers” have an exemption that does not require them to provide contraception coverage. If you happen to work for an exempt employer you can check your coverage by contacting your benefits administrator. If that employer is not a house of worship or a religious non-profit, the Department of Health and Human Services might still intervene to make sure your insurer accommodates contraception.

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:

  • Antidepressants
  • Antipsychotics
  • 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.

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