Does Medicare Cover Smoking Cessation Counseling and Treatment?

Tobacco use is the leading cause of preventable death in the United States.

According to the American Lung Association, more than 480,000 Americans die from tobacco use every year.

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.

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.

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.

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.

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.