KHN contributing columnist Michelle Andrews writes the collection Insuring Your Health, which explores well being care protection and prices.
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It was a well-intentioned effort to supply males with a number of the similar monetary safety from contraception prices that ladies get. But a brand new Maryland legislation might jeopardize the flexibility of 1000’s of customers — each women and men — to make use of well being financial savings accounts.
The legislation, which took impact Jan. 1, mandates that insurers cowl vasectomies with out requiring sufferers to pay something out-of-pocket — simply as they have to do for greater than a dozen contraception strategies for ladies.
But the measure might run afoul of Internal Revenue Service guidelines that don’t embrace vasectomies amongst authorized preventive providers for high-deductible well being plans. People with well being financial savings accounts — that are exempt from tax liabilities — tied to these plans may not contribute to the financial savings accounts in that case.
Under the Maryland Contraceptive Equity Act, insurers usually can’t cost sufferers a copayment or require every other value sharing for prescription contraceptive medication or gadgets authorized by the Food and Drug Administration. The 2016 legislation is much like what’s required underneath the federal Affordable Care Act, with a twist: It provides male sterilization — vasectomies — to the listing of providers which can be free for sufferers.
“While the ACA made important strides … it completely left men out of the equation,” mentioned Karen Nelson, president and CEO of Planned Parenthood of Maryland, whose group supported the invoice.
Before the legislation took impact, a vasectomy on the group’s Baltimore workplace would value between $225 and $1,100, relying on somebody’s potential to pay, mentioned Nelson. Now the process will usually value nothing for males in insured plans in Maryland.
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The state legislation doesn’t apply to corporations which can be “self-funded,” which means they pay their staff’ well being care claims straight quite than shopping for state-regulated insurance coverage insurance policies.
Under IRS guidelines, customers making tax-free contributions to well being financial savings accounts (HSAs) which can be linked to high-deductible well being plans must pay for all their medical care till they attain their deductible of no less than $1,350 for individuals and $2,700 for families in 2018. The solely exception is for preventive providers. The hitch for the Maryland legislation is that vasectomies aren’t on the IRS list of approved preventive services.
The IRS hasn’t responded to a request for clarification by Maryland Insurance Commissioner Al Redmer Jr. A bill was reintroduced this 12 months — after it did not go final 12 months — that might exempt these high-deductible plans from the state mandate to cowl vasectomies earlier than the deductible is met. Such a transfer would protect the tax benefits of the HSAs linked to them.
Maryland is becoming a member of a number of different states, together with Illinois, Vermont and, beginning subsequent 12 months, Oregon, which have expanded contraceptive protection with out value sharing to incorporate male sterilization.
Vermont’s legislation consists of language to exempt high-deductible plans with well being financial savings accounts. While the problem has raised considerations in Maryland, in Illinois and Oregon it hasn’t appeared to generate a lot consideration thus far, legislative analysts say.
Some advocates for extending no-cost protection to vasectomies famous that the IRS’ listing of authorized preventive providers particularly says that it isn’t exhaustive.
But till the problem is clarified, “the safest thing to do is not make a contribution to your HSA,” mentioned Roy Ramthun, a Maryland resident and president of HSA Consulting Services. Ramthun helped implement well being financial savings accounts whereas working for the Treasury Department in the course of the George W. Bush administration. He burdened that the uncertainty applies solely to HSA contributions made after the legislation grew to become efficient in 2018, to not earlier contributions. The difficulty doesn’t have an effect on individuals’s medical protection.
Beyond the uncertainty round well being financial savings account contributions, Maryland’s legislation requiring protection of vasectomies with out value sharing addresses a spot in males’s preventive protection.
“There are arguments to be made that male condoms and vasectomies have preventive benefits for both women and men, in terms of [sexually transmitted infection] prevention and preventing pregnancy,” mentioned Mara Gandal-Powers, senior counsel on the National Women’s Law Center.
Seven p.c of males ages 18 to 45 have had a vasectomy, based on a 2013 study by researchers at Northwestern University. The prevalence elevated to 16 p.c amongst males ages 36 to 45. Men with greater incomes, greater training and an everyday supply of well being care have been extra prone to have had the process, the research discovered.
The Maryland legislation doesn’t apply to the tactic of contraception that many males use: condoms. A bill introduced this month by state Sen. John Astle, a Democrat, would increase the legislation to incorporate condom protection.
Michelle Andrews: @mandrews110
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