2024 Pay or Play Affordability Percentage

CMS & IRS Take Action

CMS Issues FAQ’s on Essential Health Benefit Coverage & the Coronavirus

To remove barriers and financial disincentives to COVID-19 diagnosis and treatment, the Centers for Medicare & Medicaid Services (CMS) recently issued frequently asked questions (FAQ’s) on essential health benefit (EHB) coverage.

EHB is a core set of items and services under the Affordable Care Act (ACA) that:

  • Reflects the scope of benefits covered by a typical employer; and
  • Covers at least 10 specified categories of items and services.

Through these FAQ’s, CMS is announcing that the agency will not take enforcement action against any health issuer that amends its plans to provide coverage without imposing cost-sharing requirements for COVID-19 related services before an enrollee meets the plan’s deductible.

Exact coverage details and cost-sharing amounts for individual services may vary by plan and some may require prior authorization before services are required. Therefore, it’s important for employers to consult with their plan’s issuer and benefits administrator regarding plan specifics related to COVID-19 testing and treatment, including potential deductible applications.

IRS Allows HDHPs to Cover Coronavirus Costs

The FAQ’s align with guidance released by the Internal Revenue Service (IRS). Notice 2020-15 advises that individuals with high deductible health plans (HDHPs) can pay for COVID-19 testing and treatment before plan deductibles have been met, without jeopardizing status and still contributing to their health savings accounts (HSAs).

These early actions and guidance in response to the COVID-19 virus from both CMS and the IRS are part of the ongoing White House Task Force efforts. To stay up to date on Task Force responses, click here.

For more information specific to CMS, visit the Current Emergencies Website.