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Will Medicare cover services to help me stop smoking?


Yes. Medicare Part B covers counseling sessions and Part D covers prescription drugs to help you stop smoking.

This coverage dates to 2005, when the Centers for Medicare & Medicaid Services (CMS) determined that smoking was a preventable cause of disease and death, and found sufficient evidence to support Medicare coverage for smoking and tobacco-cessation counseling.

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Initially, this counseling was limited to those with smoking-related illnesses or who were taking medications affected by tobacco use. Since then, Medicare Part B has significantly expanded its coverage of counseling sessions to help you stop smoking.

In 2006, when Medicare launched its prescription drug benefit, Part D, it included coverage for prescription drugs used to help stop smoking. CMS recognizes a combination of counseling and an FDA-approved medication as the most effective method to quit smoking.

Tobacco use is the leading preventable cause of death and disease in the United States, according to the Centers for Disease Control and Prevention (CDC). Studies have found that even if you’re 60 or older and have been smoking for decades, stopping can still improve your health.

Smoking has long been considered a contributor and can worsen cancer, cataracts, diabetes, heart disease, hypertension, lung disease, macular degeneration, osteoporosis and stroke. It’s also linked to interfering with the effectiveness of some medications, including insulin.

How much do I pay for counseling to stop smoking?

Medicare Part B covers up to eight smoking and tobacco-use cessation counseling sessions during a 12-month period. This includes two levels of counseling, for symptomatic and asymptomatic patients. The intermediate service provides counseling from more than three to not more than 10 minutes long, and the intensive counseling service lasts longer than 10 minutes. 

You pay nothing if you follow the rules. The counseling is included in Part B’s free preventive services, which are not subject to copayments or deductibles. You'll have no out-of-pocket costs for the counseling sessions if you use a doctor or other qualified health care provider who accepts Medicare.

Medicare Advantage plans also must cover this counseling without deductibles or copayments if you use an in-network provider.

Medicare’s coverage of smoking and tobacco-use cessation counseling greatly expanded in 2011. Before then, the counseling sessions were covered only for people who showed signs of tobacco-related diseases, and you had to pay Medicare Part B deductibles and copayments. Now, any Medicare beneficiary is eligible for counseling, which is conducted individually, within a group setting or over the phone.

Does Part D cover smoking-cessation drugs?

Medicare Part D can cover prescription drugs to help you stop smoking, such as varenicline, which works in your brain to reduce nicotine withdrawal symptoms and cigarette cravings; and bupropion, an antidepressant that has been shown to help smokers stop. Part D plans may also cover what’s identified as nicotine replacement therapy medications, such as inhalers and nasal sprays that require a prescription. Medicare Advantage plans with prescription drug coverage can also cover these medications.

Private companies sell Part D plans, but Medicare regulates the plans. Each Part D plan has a different formulary, which is its list of covered drugs. The plans can also have different deductibles and copayments for the medications.

To find out how each Part D and Medicare Advantage plan in your area covers these medications, type your zip code into the Medicare Plan Finder. Then add the medicines you’re considering.

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You’ll see the total costs for the year for premiums and out-of-pocket expenses for the medications you specified. Click on View drugs & their costs for more information about the price and your coverage for each medication.

What costs to quit smoking will Medicare reject?

Medicare doesn’t cover hypnosis or devices such as e-cigarettes used to stop smoking tobacco. Medicare Part D will cover only inhalers and nasal sprays that your doctor prescribes.

It won’t cover over-the-counter nicotine replacement therapies, such as gum, lozenges, nasal spray and patches. Some Medicare Advantage plans provide a prepaid card or other allowance for over-the-counter medications as a supplemental benefit.

Keep in mind

Medicare also covers the full cost of lung cancer screening yearly for people ages 55 to 77. You must be a current smoker or have quit within the past 15 years and averaged a pack of cigarettes a day for 20 years but have no lung cancer symptoms.

This screening requires a doctor’s order. But it is considered another preventive service that Medicare covers without copayments or deductibles if your doctor accepts Medicare.

        

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