Addressing addiction care in high-deductible plans

As COVID-19 continues to drive many changes in the world of work, employers have adopted new practices around remote work increasing a sense of isolation among employees. Even employees that must work onsite are increasingly isolated in their personal lives because of new employer and state policies. This sense of isolation creates anxiety and depression, all contributing to today’s mental health crisis and increased substance use disorders. What are employers that offer High Deductible Health Plans doing to ease the pain and cost of substance use disorder?

Today, more than 80% of employers offer high deductible health plans (HDHPs), often paired with a health savings account (HSA) or health reimbursement arrangement (HRA). These health plans offer lower monthly premiums in exchange for a deductible of $1,400 or more for an individual or $2,800 or more for a family. Individuals can cover their deductible with their HSA which benefits from the “triple tax advantage”, whereby deposits are made with pretax dollars, savings grow tax-free, and eligible withdrawals incur no tax liability.

Read more: Drunk and high at work? Employers confront a new addiction crisis

While the IRS has always maintained a “safe harbor” of preventative services that do not trigger the deductible, telehealth has historically existed in a grey area and required careful analysis of the services being delivered to ensure compliance.

In April 2020, the CARES Act temporarily expanded the “safe harbor” for the 2021 plan year, to provide pre-deductible coverage for all telehealth and other remote care services. The sweeping legislation allows telehealth and other remote care services to be covered pre-deductible without violating federal rules for HDHPs. These provisions are temporary and will end sunset Dec. 31, 2021, unless Congress extends them or makes them permanent.

Unsurprisingly, Congress faces pressure to maintain telehealth after COVID-19. In June, for example, a group of more than 30 members of Congress wrote a letter to House Speaker Nancy Pelosi and her counterpart in the Senate, Mitch McConnell, to ask that emergency approval of behavioral telehealth services be extended for a transition period after the crisis ends.

Some U.S. States have taken the matter into their own hands, with Massachusetts Gov. Charlie Baker leading the charge by signing into law a wide-ranging bill that includes expanding access to telehealth after the COVID-19 public health emergency abates. In New York, Gov. Andrew M. Cuomo announced legislation to expand and improve access to telehealth for all as part of the 2021 State of the State.

While well-meaning, unilateral State action risks creating an interstate patchwork of telehealth regulation further complicating the issue for employers and providers.

While we wait for Congress to enact more lasting change, what should employers be doing?

With the expectation that this issue will be definitively revisited and clarified later this year, many employers have chosen to continue to make full use of the CARES Act and offer telehealth and remote care services as first dollar covered for the 2021 plan year. This includes virtual care programs for issues like substance use disorders, a treatment category that has been completely disrupted by the Coronavirus pandemic.

Barriers to addiction care, including a lack of available virtual treatment options, and high costs, are responsible for producing the low utilization rate of only 7.9%. While COVID-19 will begin to fade with the distribution of a vaccine, it is clear that the behaviors of today will become the addictions of tomorrow, and of course, there will not be a vaccine for substance use disorder.

According to a recent employer survey conducted by Willis Towers Watson, 51% of employers are offering virtual or coaching solutions for behavioral health conditions as a means of improving health and decreasing costs, while 52% of employers think that telemedicine will be an important priority post-pandemic.

Research into the Quit Genius client base shows that employees with multiple addictions can cost employers between $16K-$21K annually, almost 3x more than non abusers. This all hits the employer through medical insurance claims. Offering a comprehensive virtual behavioral health program without a deductible is crucial in driving treatment utilization and will ultimately drive success, decreasing these long term healthcare costs that are related to substance use disorder.

Substance use disorder and behavioral health treatments are examples of why employers are, and should be, responding in force with virtual care programs to continue to take care of the health and well-being of their employees. Virtual care programs are critical for treating patients who are not able to make it into the physical office and who also have ongoing health issues that must be treated during the pandemic.