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."