Does Medicare Cover Smoking Cessation Counseling and Treatment?
If you’re a smoker on Medicare, you can receive up to eight free smoking cessation counseling sessions each year at no cost to you. Medicare Part D plans and Medicare Advantage plans also cover certain prescription drugs used to help you stop smoking.
Medicare’s Coverage of Smoking Cessation Counseling
Tobacco use is the leading cause of preventable death in the United States.
About 440,000 people die each year from smoking-related diseases, and 68 percent are age 65 or older.
Older adults who quit smoking can reduce their risk of death from various conditions, including coronary heart disease, chronic obstructive lung disease and lung cancer.
Smoking cessation counseling has been available as a Medicare-covered service since 2006.
Medicare will cover up to two smoking cessation attempts each year.
Each attempt includes a maximum of four counseling sessions, or a total of up to eight sessions in a 12-month period.
During counseling sessions, a doctor or therapist will provide you with personalized advice on how to quit.
- Develop a plan to quit smoking.
- Identify situations and environments that trigger your urge to smoke.
- Find smoking alternatives and distractions, such as brushing your teeth or taking a walk.
- Eliminate smoking products from your home and car, including lighters, matches and ash trays.
- Learn about the health benefits of smoking cessation.
- Practice coping mechanisms for emotional and physical withdrawal symptoms.
You and your health care provider can choose between intermediate or intensive cessation sessions for each attempt.
Intermediate sessions last more than three minutes but less than 10 minutes, while intensive sessions last more than 10 minutes.
You can receive counseling in various settings, including over the phone and in group sessions.
If you’re a Medicare beneficiary who uses tobacco, you qualify for free cessation counseling. You don’t need to have any signs or symptoms of tobacco-related disease to qualify.
- You use tobacco.
- You are competent and alert while counseling is provided.
- Your counseling is provided by a qualified physician or other Medicare-recognized practitioner.
There are no coinsurance payments or deductibles for smoking cessation counseling because the Patient Protection and Affordable Care Act waives deductibles and coinsurance for certain preventive services.
Tobacco cessation counseling is covered by Medicare in outpatient and hospital settings.
However, Medicare will not cover tobacco cessation services in a hospital if the principal diagnosis is tobacco use disorder and tobacco cessation is the primary reason for your hospital stay.
Does Medicare Cover Chantix and Other Prescriptions?
In addition to counseling, your doctor may prescribe a medication to help you stop smoking — such as varenicline, also known by the brand name Chantix.
Since 2006, Medicare Part D drug plans have included certain smoking cessation drugs.
- Nicotine replacement therapy inhalers
- Nicotine replacement therapy nasal spray
- Bupropion (Zyban)
- Varenicline (Chantix)
Common over-the-counter medications, such as nicotine gum and patches, are not covered by Medicare.
However, certain Medicare Advantage plans may include some coverage or discounts on these products.
Costs for nicotine replacement therapy drugs can vary from plan to plan, but these prescriptions are often free or affordable for Medicare beneficiaries.
According to GoodRx, the average Medicare user pays $1 to $9 for a 30-day supply of Chantix, while the average cost for Zyban is $1.
Medicare Advantage plans with prescription drug coverage offer the same benefits as stand-alone Part D plans.
6 Cited Research Articles
- U.S. Centers for Disease Control and Prevention. (2020, September 10). Coverage for Tobacco Use Cessation Treatments. Retrieved from https://www.cdc.gov/tobacco/quit_smoking/cessation/coverage/index.htm
- United Healthcare. (2020, June 10). Counseling to Prevent Tobacco Use (NCD 210.4.1). Retrieved from https://www.uhcprovider.com/content/dam/provider/docs/public/policies/medadv-guidelines/c/counseling-prevent-tobacco-use.pdf
- U.S. Centers for Medicare & Medicaid Services. (2005, March 22). Decision Memo for Smoking & Tobacco Use Cessation Counseling (CAG-00241N). Retrieved from https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=130
- GoodRx. (n.d.). Chantix Medicare Coverage. Retrieved from https://www.goodrx.com/chantix/medicare-coverage
- GoodRx. (n.d.). Zyban Medicare Coverage. Retrieved from ttps://www.goodrx.com/zyban/medicare-coverage
- Medicare.gov. (n.d.). Counseling to prevent tobacco use & tobacco-caused disease. Retrieved from https://www.medicare.gov/coverage/counseling-to-prevent-tobacco-use-tobacco-caused-disease