Does Medicare Cover Smoking Cessation Treatments?
This article was updated on: 09/12/2018
According to the Centers for Disease Control and Prevention (CDC), people who stop smoking greatly reduce their risk for smoking-related diseases and early death. Smoking cessation is beneficial at any age, according to the CDC. Medicare will cover up to eight face-to-face smoking cessation counseling visits in a 12-month period, if the visits are provided by a qualified physician or other practitioner who accepts Medicare assignment. Please remember that you are never too old to quit.
Read on for details about how Medicare Part B covers smoking cessation treatments for anyone who wants to quit smoking, whether you have related health issues or not.
Around 40 million American adults (about 17% of the population) smoke, the Centers for Disease Control reported in 2014. More than 16 million have a health condition related to smoking.
How does Medicare pay for smoking cessation counseling visits?
Original Medicare is made up of Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). Smoking cessation treatment is covered under your Part B benefits, and you may be eligible to get up to eight counseling sessions at no cost to you.
The following conditions for smoking cessation visits or counseling sessions apply:
- The counseling sessions must be provided by a licensed physician or other Medicare-approved practitioner.
- Your health-care provider must accept Medicare assignment.
- The eight sessions must occur in one 12-month period, and you’re eligible for further counseling during the next 12-month period.
What if I need more help quitting smoking?
According to the CDC, quitting smoking is difficult (research suggests that nicotine may be as addictive as heroin, cocaine, and alcohol) and may require several attempts; people who have tried smoking cessation may begin again because of withdrawal symptoms, stress, or weight gain. If you need help beyond the Medicare-covered smoking cessation counseling, you may have other options.
According to the CDC, the following ways have been proven effective for smokers who want help quitting:
- Talking briefly to your doctor for advice
- Attending individual or group counseling sessions, in person or by phone
- Trying behavioral therapies like problem-solving training
- Using programs that deliver treatments via mobile phones, such as advice and tips via text message on your mobile phone
- According to the CDC, there are also certain medications for smoking cessation that have been found to be effective, including:
- Nicotine-replacement products
- Over-the-counter products like nicotine patches, gums, or lozenges
- Prescription products like nicotine patches, inhalers, or nasal sprays
- Prescription non-nicotine medications, like Zyban or Chantix
Please note that according to the CDC, counseling and medications are both effective for smoking cessation, and using them together is more effective than trying either one alone.
Medicare plans with prescription drug coverage
If your physician prescribes prescription drugs to help with smoking cessation, please note that Original Medicare coverage of prescription drugs is limited, and generally doesn’t cover medications you take at home. A stand-alone Medicare Prescription Drug Plan offered by a Medicare-approved private insurance company can help you cover the costs of prescription drugs. You’ll have to check with the plan to make sure that the prescription drugs (such as smoking cessation medications) are on the plan’s formulary, which is a list of covered prescription drugs. Please note that the formulary may change at any time, and you will receive a notice from your plan when necessary.
There is another way to receive prescription drug coverage—through a Medicare Advantage Prescription Drug plan. Some people receive their Original Medicare benefits through an alternative method called a Medicare Advantage plan (except for hospice care benefits, which Part A still provides). The vast majority of Medicare Advantage plans include prescription drug coverage, which may cover certain prescription medications used in smoking cessation. Again, please check the plan’s formulary.
Medicare Advantage plans must cover all the treatment, equipment, and services covered by Original Medicare, but they may also offer additional benefits such as routine dental and vision care and wellness benefits. Please note that you’ll need to continue paying your monthly Medicare Part B premium, along with any premium the Medicare Advantage plan charges. Also, every Medicare Advantage plan is different, and deductibles, copays, and coinsurance may apply.
Where can I get more information about Medicare coverage for smoking cessation?
Quitting smoking is never easy, and many people need support in order to succeed. The good news is that, if you are eligible for Medicare, you may have options to help you quit. I’d be happy to discuss your Medicare plan options with you if you’d like. Want to schedule a phone call or request a personalized email? Click on one of the links below. You can also see a list of plan options you may be eligible for in your area by clicking the Compare Plans button. Click on the “View profile” link to learn more about me.
For more information about quitting smoking, see:
“Quitting Smoking,” Centers for Disease Control and Prevention (CDC), last modified May 21, 2015, http://www.cdc.gov/tobacco/data_statistics/fact_sheets/cessation/quitting/
“Reducing Tobacco Use and Secondhand Smoke Exposure: Mobile Phone-Based Cessation Interventions,” Guide to Community Preventive Services, last modified April 22, 2016, https://www.thecommunityguide.org/tobacco/mobilephone.html