Pre-Deductible Telehealth Coverage Extension Included in 2023 Spending Bill

​Employers will have the option to provide pre-deductible coverage of telehealth services for people with high-deductible health plans for another two years.

The $1.7 trillion omnibus spending bill signed into law by President Joe Biden Dec. 29—which contains a number of other important provisions affecting employers, including the Secure 2.0 retirement overhaul and pregnancy accommodations—includes a provision extending the telehealth relief in the 2020 Coronavirus Aid, Relief and Economic Security (CARES) Act.

Significantly for employers, the provision allows health savings account (HSA)-qualifying high-deductible health plans (HDHPs) to cover telehealth and other remote-care services on a pre-deductible basis. Additionally, an otherwise HSA-eligible individual can receive pre-deductible coverage for telehealth and other remote-care services from a stand-alone vendor outside of the HDHP, consulting firm Mercer reported. In both cases, the pre-deductible telehealth coverage won't hinder an individual's eligibility to make or receive HSA contributions. Many employer groups and stakeholders have said that the waiver improves health access, notably for some employees who may have avoided telehealth because of out-of-pocket expenses.

SHRM has been advocating for the continuation of pre-deductible telehealth coverage, arguing that improved access to telehealth allows employees to access more health care options—including mental health services—at their convenience.

"Pre-deductible coverage helps employees because it allows insurance providers to cover telehealth services without requiring a co-pay or deductible upfront," said Emily Dickens, SHRM chief of staff, head of public affairs and corporate secretary. "Employers need the flexibility to design benefit plans that improve employees' well-being and help retain top talent. I am grateful to our members for engaging with lawmakers from across the nation to secure this extension."

The CARES Act allowed HSA-eligible health plans to provide pre-deductible coverage for telehealth services, but only through 2021. Normal cost-sharing was still allowed for telehealth visits, such as through co-pays that the plan may require after the deductible is paid. It was then renewed in the 2022 Consolidated Appropriations Act for April 1 through Dec. 31, 2022.

The omnibus bill also extends Medicare telehealth provisions for another two years, including delaying in-person screening requirements for Medicare telehealth mental health services and allowing providers to provide acute hospital-level care at home.

Still, the extensions don't permanently extend telehealth relief—something many health and policy experts advocate for. Without a further extension, the telehealth relief will expire Dec. 31, 2024, for calendar-year plans. Some groups expect Congress might make these changes permanent, although some lawmakers are concerned with telehealth's potential for higher costs and increased fraud.

The telehealth extension is the right move because "telehealth has proven to be an often lifesaving and widely valued option for millions of Americans," the American Telemedicine Association's senior vice president of public policy, Kyle Zebley, said in a statement.

Telehealth use soared during the pandemic, with more employees turning to the option and more employers expanding coverage. SHRM research, for instance, found that 43 percent of organizations expanded telehealth services throughout the COVID-19 pandemic, while 49 percent maintained existing telehealth benefits.