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Medicare Coverage for Smoking Cessation Treatments

Summary: Medicare covers smoking cessation treatments when deemed medically necessary. These treatments help individuals addicted to smoking quit the bad habit to live longer and healthier lives. Estimated Read Time: 6 min

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Smoking is one of the leading causes of preventable death and disease worldwide, and despite its well-known health risks, many people still struggle to quit. Luckily, in the United States, Medicare provides healthcare coverage for millions of individuals aged 65 and older who want to end their bad habit of smoking and using tobacco products. Medicare smoking cessation programs can help improve your overall health and allows you to live longer with your loved ones.

Medicare offers several smoking cessation treatment options to eligible beneficiaries. In this article, we will explore the various Medicare smoking treatment options available, including counseling, medication, and other resources, and discuss how these programs can help individuals quit smoking and improve their health and well-being.

Medicare Coverage for Smoking Cessation

Most people associate cigarette smoking with lung disease. But many don’t realize that smoking causes harm throughout the entire body in many ways. Smoking doesn’t just cause people to die sooner from cancer. Smokers are more prone to diseases that lower their quality of life.

For example, smoking can cause strokes and lung diseases like COPD and emphysema. It can cause cancer in almost any part of the body. It affects bone, tooth, and eye health and can cause type 2 diabetes and rheumatoid arthritis. Quitting smoking reduces these risks in a relatively short amount of time.

Research shows that one-on-one smoking cessation counseling is an effective way to help older adults quit. Because of this, Medicare added smoking cessation to its list of benefits in the mid-2000s.

Does Medicare Cover Smoking Cessation?

Medicare Part B medical coverage will pay for smoking cessation counseling provided by a healthcare provider. Your Medicare coverage may also pay for certain medications that may make it easier for you to quit.

Medicare recognizes that smoking is a significant health risk and that quitting smoking is an important step in improving health outcomes for individuals. Therefore, Medicare provides coverage for several smoking cessation treatments, including counseling and medication, to help beneficiaries quit smoking.

A few FDA-approved medications for smoking cessation covered by Medicare include nicotine replacement therapies (such as patches, gum, and lozenges) and prescription medications (such as bupropion and varenicline).

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It’s important to note that Medicare coverage for smoking cessation varies based on your specific plan and coverage option. It’s always a good idea to check with Medicare or your healthcare provider to confirm coverage details and eligibility for smoking cessation treatments.

What is Smoking Cessation Counseling?

Smoking cessation counseling is a form of counseling or therapy that helps individuals quit smoking. It involves a structured program that includes counseling, education, and behavioral therapy to help individuals overcome their addiction to nicotine and develop skills to maintain a smoke-free lifestyle.

The process of smoking cessation counseling typically begins with an assessment of your smoking habits, history, and motivation to quit. The counselor will then work with you to develop a personalized quit plan, which may include strategies such as setting a quit date, identifying triggers for smoking, developing coping strategies for cravings, and finding alternative ways to manage stress.

Throughout the counseling process, the counselor will provide you with support and guidance to help you stay motivated and on track with your quit plan. This may include regular check-ins, feedback on progress, and adjustments to the quit plan as needed.

Smoking cessation counseling may be provided by healthcare professionals such as physicians, nurses, psychologists, or by trained smoking cessation specialists. It can also be provided in individual or group settings and may be offered through a variety of channels including in-person sessions, phone counseling, or online programs.

Does Medicare Cover Smoking Cessation Prescriptions?

Medicare will cover certain prescription drugs to help you stop smoking. However, Medicare does not cover over-the-counter medications or stop-smoking aids like nicotine gum. To get prescription coverage, you must have a Medicare Part D Prescription Drug plan or a Medicare Advantage plan that includes prescriptions.

Your plan should cover these smoking cessation medications:

  • NRT inhaler
  • NRT nasal spray
  • Bupropion or Zyban
  • Varenicline, also known as Chantix

You may be responsible for part of the cost of these medications. The amount you’ll pay will depend on your plan and the amount you spend on prescriptions this year.

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How Much Will Medicare Cover Smoking Cessation?

Medicare will pay 100% of the cost of counseling to help you quit smoking. However, your counseling only has coverage if you get it from a doctor or specialist. You have coverage for up to eight sessions of counseling each year until you can quit for good.

To get the full smoking cessation coverage, be sure your provider accepts Medicare assignment. If you sign up for a smoking cessation plan that you find online or advertised in your community, be sure to ask if Medicare covers it before you commit.

Does Medicare Advantage Cover Smoking Cessation?

Medicare Advantage plans are required by law to cover smoking cessation counseling and medication.

However, coverage and costs for smoking cessation counseling and medication can vary depending on the specific Medicare Advantage plan. Some plans may offer additional coverage and benefits beyond what is covered by traditional Medicare. It’s important to review the specific policy terms of a Medicare Advantage plan to determine what is covered and any potential out-of-pocket costs.

Does Medicare Cover Chantix?

Chantix is a medication designed to help you slowly quit smoking. If you have a Medicare Part D plan or prescription coverage in your Medicare Advantage plan, it should cover the generic version of Chantix, varenicline. The out-of-pocket costs will depend on your plan and how much you have spent on prescriptions this year.

How Often Does Medicare Pay for Smoking Cessation?

Medicare will pay for eight smoking cessation sessions per year. So, if you can’t quit the first time around, you can try again during the next calendar year, and Medicare will pay for it.

How to Get Medicare Coverage for Smoking Cessation

Did you know that smoking is almost three times more common for people with mental illness? Those with three or more mental health disorders are 61% more likely to smoke.

With a Medigap plan, you don’t need to stress about possible costly diseases because the coverage protects you from needing to dip into your retirement savings. These plans require a premium; however, the out-of-pocket costs are minimal, unlike Medicare Advantage plans where you pay more as you go.

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We can compare all your supplemental Medicare options, including Medigap, Medicare Advantage, and Part D. Give us a call, or fill out an online rate form and see all the options available in your area to cover Medicare smoking cessation programs.

Kayla Hopkins

Kayla Hopkins

Content Editor
Kayla Hopkins is an accomplished writer and Medicare guru serving as the Editor of MedicareFAQ.com. Upon completing her Communications degree from Ohio University, Kayla dedicated her time to understanding the ever-evolving landscape of healthcare. With her extensive background as a Licensed Medicare Insurance Agent, she brings a wealth of knowledge and expertise to her writing.
Ashlee Zareczny

Ashlee Zareczny

Compliance Manager
Ashlee Zareczny is the Compliance Manager for MedicareFAQ. As a licensed Medicare agent in all 50 states, she is dedicated to educating those eligible for Medicare by providing the necessary resources and tools. Additionally, Ashlee trains new and tenured Medicare agents on CMS compliance guidelines. Ashlee is a Medicare expert who specializes in Medicare Supplement, Medicare Advantage, and Medicare Part D education.

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