In the past, Medicare has covered antismoking counseling only for those who have already developed health problems from tobacco use. These sessions require a 20 percent copayment and are subject to the annual Part B deductible.
But the new benefit at last puts the horse before the cart: It's for people who have no symptoms of tobacco-related diseases but want to quit smoking before it harms their health. And there's no copay or deductible for this counseling, provided that you see a doctor or other qualified practitioner who accepts the Medicare-approved payment as full reimbursement.
Among the 46 million Americans who smoke, about 5.5 million are Medicare beneficiaries, according to the Department of Health and Human Services. And a recent CDC study (PDF) found that more than 50 percent of smokers age 65 and older said they wanted to stop completely.
Tobacco use is the leading cause of preventable illness, responsible for an estimated one-fifth of deaths in the United States each year, and by 2015 it will have cost Medicare $800 billion over a 20-year period, according to an estimate by the Centers for Disease Control and Prevention.
The new coverage allows up to two "quit-smoking" attempts a year, and each attempt includes up to four counseling sessions — a total of eight in any 12-month period. So if you have the first session in March, for example, and the next seven sessions don't break your habit, you can start another attempt the following March and have up to seven more sessions over the next 11 months, and so on.
What happens in these sessions? Medicare officials haven't released specifics, but recommend that doctors follow the "5-A" approach formulated by the federal government 11 years ago: ask patients about their smoking habits; advise them to quit; assess their willingness to quit; assist their attempts to quit; and arrange follow-up.
To help the process, doctors also may prescribe one of seven antismoking drugs currently approved by the Food and Drug Administration. These medications are covered under the Medicare Part D drug program.
Research shows that either counseling or medications are effective in helping people to quit smoking. "But what is most effective is when you combine the two," says Michael C. Fiore, M.D., professor of medicine and director of the Center for Tobacco Research and Intervention at the University of Wisconsin. "That's why Medicare now covering counseling is so important."
With nicotine said to be more addictive than heroin, quitting cold turkey is a tough call for many smokers. Without help, fewer than 7 percent manage it; but with assistance from antismoking programs, success rates more than quadruple (PDF), according to a report from the American College of Physicians.
"No matter how you cut it, quitting does take commitment and hard work," says Fiore, who describes tobacco dependence as a chronic disease. No doctor would tell you to control diabetes or high blood pressure just by using willpower, he adds. "Similarly, you want to take advantage of all the medical tools — medications and counseling — that can enhance the likelihood that you'll successfully quit."
What about older Americans who have been smoking for 30, 40 or 50 years and feel that it's too late for them — that the damage is already done? In fact, Fiore says, research shows that quitting is especially beneficial for them, and not just because they'll be able to climb the stairs without gasping for breath: "Your risk of heart attack will decline 50 percent within one year of quitting. Your risk of cancer within five years of quitting will begin to approach that of a person who's never smoked. If you quit at age 50, your risk of dying in the next 15 years is cut in half. So it's never too late to quit."
Nov. 17 is the 36th Great American Smokeout, an annual event sponsored by the American Cancer Society to encourage smokers to stop for at least one day in the hope that they'll continue permanently. To mark the event, the Society for Vascular Surgery issued a checklist of what would happen to smokers by Nov. 19, only 48 hours after quitting:
- Blood pressure will decrease.
- Pulse rate will drop.
- Body temperature of hands and feet will increase.
- Carbon monoxide level in the blood will return to normal.
- Chance of a heart attack will decrease.
- Nerve endings will start to regrow.
- Ability to taste and smell will increase.
Patricia Barry is a senior editor with the AARP Bulletin.
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