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Since smoking is both psychologically and physically addictive, it is very hard to quit the smoking habit. Because of this, smokers often look for help in aiding them to stop smoking. While there are many stop smoking programs available, most of them are not affordable for many smokers.
Since smoking is both psychologically and physically addictive, it is very hard to quit the smoking habit. Because of this, smokers often look for help in aiding them to stop smoking. While there are many stop smoking programs available, most of them are not affordable for many smokers.
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Thanks largely to legal provisions in the Affordable Care Act (ACA), many private health insurance providers will cover various types of smoking cessation (stop smoking) treatments and programs. This varies depending on the specific insurance provider. However, the ACA mandated smoking cessation coverage for the following groups of people.
Thanks largely to legal provisions in the Affordable Care Act (ACA), many private health insurance providers will cover various types of smoking cessation (stop smoking) treatments and programs. This varies depending on the specific insurance provider. However, the ACA mandated smoking cessation coverage for the following groups of people.
Medicare Coverage
Everyone enrolled in Medicare is entitled to coverage for smoking cessation. The costs involved will be covered by Medicare Part B and Part D (prescription drug coverage) or Medicare Advantage (Part C) for those enrolled in this. The coverage provided includes the following:
Four sessions of individual, specialized smoking cessation counseling.
Cessation prescription medications: usually limited to nicotine nasal spray, nicotine inhaler, bupropion and varenicline.
However, Part D (prescription medicine) plans may cover a broader choice of medications.
No cost sharing (co-pay) for most treatments, but annual deductibles may still apply.
Above treatment regimen is limited to two attempts per year.
Medicaid Coverage
Medicaid programs are run by the individual states, usually covering low-income and disabled individuals. The ACA mandated coverage for the following smoking cessation treatments:
No prior authorization required to receive treatments.
No cost sharing (co-pay) or deductibles.
Four sessions of individual, group and phone counseling.
90 day supply of all FDA-approved smoking cessation prescription medications.
Limit of two treatment regimens per year.
State Health Insurance Marketplace Plans
The following coverage is mandated for individuals who did not qualify for Medicaid, don’t have employer provided group insurance and can’t afford to buy a private health insurance policy:
No prior authorization required to receive treatments.
No cost sharing (co-pay) or deductibles.
Four sessions of individual, group and phone counseling.
90 day supply of all FDA-approved smoking cessation prescription medications.
Limit of two treatment regimens per year.
Private Group Health Insurance Plans
Coverage mandated for individuals who receive their health insurance through their employer, association, union or other organization:
No prior authorization required to receive treatments.
No cost sharing (co-pay) or deductibles.
Four sessions of individual, group and phone counseling.
90 day supply of all FDA-approved smoking cessation prescription medications.
Limit of two treatment regimens per year.
