Does Medicaid Cover Smoking Cessation

Date:

Smoking And Vaping: Medicaid Benefits

MMWR Visual Abstract: Smoking Cessation for Medicaid

Medicaid covers treatment for smoking and vaping:

  • Unlimited quit counseling.
  • All seven tobacco-treatment medications approved by the Food and Drug Administration .
  • Five nicotine medications: the patch, gum, lozenge, spray and inhaler
  • Two non-nicotine pills: bupropion SR and varenicline
  • Using two nicotine medications at the same time. This is safe for most people, and can be even more helpful in reducing cravings and other withdrawal symptoms.
  • Medicaid does not limit the number of prescriptions covered, no matter how long you need help managing cravings or withdrawal symptoms.

    If you need to find health insurance that can cover your treatment, Health Department enrollment counselors can help you sign up for low- or no-cost health insurance, including Medicaid.

    Talk with your health care provider to decide which treatment might be right for you.

    Resources for Providers

    • Note the following updates regarding smoking cessation counseling coverage through Medicaid:
    • Counseling expansion effective August 1, 2020, for FFS and November 1, 2020 for HMO: All medically necessary cessation counseling sessions are covered, with no maximum.
    • Expanded list of billable providers effective April 1,2021: The list of billable healthcare providers now includes CP, LCSW, LMSW, RN, LPN providers in addition to MD, DO, PA, NP, LMW/CNM, DMD, DDS, and dental hygienists.
  • To ensure medication coverage by Medicaid:
  • Write prescriptions for up to a 30-day supply, with refills as appropriate.
  • 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 Part D prescription drug plan or a Medicare Advantage plan that includes prescriptions.

    Your plan should cover these smoking cessation medications:

    • Bupropion or Zyban
    • Varenicline, also known as Chantix

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

    Find Medicare Plans in 3 Easy Steps

    We can help find the right Medicare plans for you today

    Reap The Benefits Of Being Smoke

    Brighter smile. Clearer skin. Decreased heart risks. Lower cholesterol. These are just a few of the many benefits of being smoke-free. Quitting may seem hard. But stay positive. Think of all the good things that come with it.

    Maybe you or someone you know already tried to quit but didnt have much luck. Thats OK. Everyones quit journey is different.

    Also Check: Nursing Homes In Huntsville Al That Take Medicaid

    How Does The Program Work

    Medical reports have shown that smokers have a higher level of endorphins. These are the bodys natural calming and stimulating chemicals which are triggered by the intake of cigarette smoke. These are the least harmful effects from smoking. Its the many other toxic, caustic, carcinogins and chemicals a smoker intakes that are particularly deadly. When you stop smoking, the sudden drop in endorphins is the main reason for the craving effect.L.L.L.T. used on acupuncture points, helps to stimulate and maintain the bodys natural mechanism to balance the endorphin levels. It is completely safe, painless and even relaxing, using Laser pure light energy. Laser light is providing a success in many other forms of therapy as well as addictions, e.g. Physiotherapy, Sports injuries, Problem tissue healing, as well as a brilliant tool in Acupuncture.

    Insurance Coverage And Billing

    HEALTH

    State law requires health plans to cover the same preventive services required by federal law in 2016, which include tobacco cessation services, as outlined in Affordable Care Act implementation guidance.

    This means that in addition to screening for tobacco use providers should be able to bill for the following services without prior authorization and cost to their client, at least twice per year, per client:

    • Four counseling sessions, lasting at least 10 minutes, delivered:
    • Individually, face-to-face
    • Individually, over the phone
    • In a group setting
  • A 90-day supply of medications approved by the FDA for tobacco cessation:
  • Over-the-counter nicotine replacement therapy , including the patch, gum, and lozenge
  • Prescription NRT
  • Prescription non-nicotine medication .
  • Health plans may require a prescription to reimburse clients for OTC NRT. Consider combining use of nicotine gum or lozenges with nicotine patches to triple your clients’ chances of quitting.

    Results from a 2019 survey of insurance carriers in Washington state suggest that:

    If you find a health plan that does not cover tobacco cessation services for their members, visit the Office of the Insurance Commissioner .

    See Commercial Tobacco Use and Dependence Treatment in Washington State for more information.

    Recommended Reading: State Of Michigan Medicaid Phone Number

    Remember: Youre Never Too Old To Quit Smoking Or Using Tobacco

    When you quit, you can look forward to these health benefits:

    3 days: nicotine has left your body

    1 year: risk of coronary heart disease cuts in half

    2-5 years: risk of mouth, throat, esophagus and bladder cancer cuts in half risk of stroke reduces to that of a non-tobacco user

    10 years: half as likely to die from lung cancer risk of kidney or pancreatic cancer decreases

    15 years: risk of coronary heart disease drops to a non-tobacco userâs

    Medicare Adds Coverage Of Smoking And Other Tobacco Use Cessation Services

    opens in new windowopens in new windowopens in new windowMEDICARE ADDS COVERAGE OF SMOKING AND OTHER TOBACCO USE CESSATION SERVICES

    The Centers for Medicare and Medicaid today announced it is adding coverage for smoking and tobacco use cessation counseling for certain beneficiaries that will help them quit the habit.

    Covering smoking and tobacco use cessation counseling for seniors has great potential to save and improve lives for millions of seniors, said CMS Administrator Mark B. McClellan, M.D., Ph.D. This is another step in turning Medicare into a prevention-oriented health program.

    The coverage decision, which was proposed for public comment in December, involves Medicare beneficiaries who have an illness caused or complicated by tobacco use, including heart disease, cerebrovascular disease, lung disease, weak bones, blood clots, and cataracts the diseases that account for the bulk of Medicare spending today. It also applies to beneficiaries who take any of the many medications whose effectiveness is complicated by tobacco use including insulins and medicines for high blood pressure, blood clots and depression.

    The evidence fully supports the hope that seniors with diseases and health effects caused by smoking and tobacco use can quit, given the right assistance, McClellan said.

    Medicares upcoming prescription drug benefit will cover smoking cessation treatments that are prescribed by a physician.

    Also Check: Meridian Medicaid Illinois Phone Number

    How Much Does Chantix Cost

    When you have Medicare, your costs for Chantix may depend on how you pay for your medications and what coverage stage you are in.

    According to GoodRx, Chantix costs about $8 to $9 for a copayment until youve met your deductible. After that time, Chantix usually costs anywhere from $1 to $9.

    If youre wondering exactly what Chantix will cost you, you can visit the GoodRx website and enter information about your specific Medicare prescription drug plan by clicking the See My Plans Prices button.

    These costs are estimates and may vary based on your plan, the pharmacy you use, and the amount in your supply.

    You can also contact your plan to find a list of approved pharmacies or contact the pharmacy to find an estimated listing of costs.

    Less Than 10 Percent Of Smokers In Medicaid

    Medicaid Tobacco Cessation Coverage in Oregon: A Case Study

    February 21, 2022 – Medicaid fee-for-service beneficiaries who tried to quit smoking cigarettes rarely accessed cessation medication or counseling despite the wide range of cessation treatments that Medicaid covers, a study published in Nicotine & Tobacco Research found.

    Individuals enrolled in Medicaid are more likely to smoke cigarettes than individuals with private health insurance. Smoking cessation treatments, such as counseling and seven FDA-approved medications, can help individuals quit smoking and reduce smoking-related morbidity and mortality.

    To understand how often Medicaid fee-for-service beneficiaries utilized cessation treatment and the spending associated with it, researchers gathered Medicaid claims data from the Medicaid Analytic eXtract files from 2010 to 2014.

    Dig Deeper

    They used the most recent data for each state and the District of Columbia, including data from 2014 for 17 states, 2013 for 11 states, 2012 for 20 states, 2011 for two states, and data from 2010 for one state. They estimated the number of beneficiaries who tried to quit smoking using the Behavioral Risk Factor Surveillance System data.

    Thirty-seven states reported cessation medication claims for Medicare fee-for-service beneficiaries. Among these states, 24 offered Medicaid coverage for all seven medications.

    There was an average rate of 4.3 counseling services per 100 beneficiaries who tried to quit smoking.

    Don’t Miss: How Many Medicaid Programs Are There

    Knowing The Risks Of E

    Recently, theres been a rise in people turning to e-cigarettes and vaping. Some believe that its a safe way to transition from quitting cigarettes to not smoking at all. Its important to know that theres nicotine in traditional cigarettes as well as e-cigarettes. Its highly addictive. And e-cigarettes havent been approved by the U.S. Food and Drug Administration as a smoking cessation device.1

    There are still many things that we dont know about vaping. Its still unknown what chemicals are used in the vapor and how they affect your health. Thats why its important to go to your family, friends or care team for support.

    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 dont 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.

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

    Find Medicare Plans in 3 Easy Steps

    We can help find the right Medicare plans for you today

    • Was this article helpful ?

    Also Check: Medicaid Administrative Office Columbia Sc

    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.

    Smoking Cessation Drugs Covered by Medicare Part D

    • Nicotine replacement therapy inhalers

    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.

    Also Check: Whatâs The Eligibility For Medicare

    Insurance Type: State Health Insurance Marketplace Plans

    State Medicaid Coverage for Tobacco

    Who’s Covered?

    Individuals who buy plans through healthcare.gov or their states marketplace. Subsidies for these plans are available to those earning 100-400% of the federal poverty level.

    Required Coverage

    • Tobacco cessation as a preventive service. Federal guidance defines this as:
    • 4 sessions of individual, group and phone counseling
    • 90 days of all FDA-approved smoking cessation medications
    • 2 quit attempts per year
    • No prior authorization for treatments
  • No cost-sharing
  • Individuals who receive health insurance through their employer, association, union or other organization.

    Required Coverage

    • Tobacco cessation as a preventive service. Federal guidance defines this as:
    • 4 sessions of individual, group and phone counseling
    • 90 days of all FDA-approved smoking cessation medications
    • 2 quit attempts per year
    • No prior authorization for treatments
  • No cost-sharing
  • You May Like: Where Do I Find My Medicaid Number

    Medigap Plans Can Help Cover Covered Medicare Tobacco Cessation Treatment

    If Medicare covers your smoking cessation counseling or other treatment, you will typically have to pay certain out-of-pocket costs such as copays, deductibles and coinsurance.

    A Medicare Supplement Insurance plan can help cover some of these costs.

    For example, each of the 10 standardized Medigap plans that are available in most states provide coverage for the Medicare Part B coinsurance or copayments you might face when you receive covered outpatient smoking cessation treatments.

    A licensed agent can help you find a Medigap plan that works for you. Call today to speak with a licensed agent and compare the Medigap plans that are available where you live.

    1 10-minute claim is based solely on the time to complete the e-application if you have your Medicare card and other pertinent information available when you apply. The time to shop for plans, compare rates, and estimate drug costs is not factored into the claim. Application time could be longer. Actual time to enroll will depend on the consumer and their plan comparison needs.

    Christian Worstell is a health care and policy writer for MedicareSupplement.com. He has written hundreds of articles helping people better understand their Medicare coverage options.

    How Can I Get Help To Cover My Prescription Drug Costs

    The following programs may help you save money on your medications:

    • Medicaid. Medicaid is a state-run assistance program that can help you pay for medications if you have trouble affording them. to learn more about Medicaids state prescription drug resources.
    • Medicare Extra Help program. The Medicare Extra Help program provides prescription drug cost assistance for those who meet income qualifications. These criteria change on a yearly basis, so check your status each year.
    • Medicare savings programs. A Medicare savings program helps you pay for healthcare costs including prescription drugs. If you qualify for a savings program, you also automatically qualify for Extra Help.
    • Local community assistance programs. Several community organizations, including extensions of nonprofit chapters like the American Heart Association and the Program of All-Inclusive Care for the Elderly may provide assistance with medications.
    • Manufacturer coupons. Many prescription drug manufacturers offer discount coupons that you can either mail in after you use the coupon or submit directly to your pharmacy to save money on your medications.
    • Prescription drug discount websites. There are several websites that offer prescription drug discount cards or other information on medicine cost-savings. Examples of these include AmericasPharmacy, Choice Drug Card, GoodRx, and ScriptSave WellRx.

    You May Like: Mosquito Repellent Covered By Medicaid

    Does Medicare Cover Smoking Cessation Treatments

    Summary:

    Smoking cessation treatment is covered under your Part B benefits, and you may be eligible to get up to eight counseling sessions at no cost to you. Hereâs more about this Medicare coverage.

    According to the Centers for Disease Control and Prevention , people who stop smoking greatly reduce their risk for smoking-related diseases and early death. Smoking cessation is beneficial at any age, according to the CDC. Medicare will cover up to eight face-to-face smoking cessation counseling visits in a 12-month period, if the visits are provided by a qualified physician or other practitioner who accepts Medicare assignment. Please remember that you are never too old to quit.

    Read on for details about how Medicare Part B covers smoking cessation treatments for anyone who wants to quit smoking, whether you have related health issues or not.

    Around 40 million American adults smoke, the Centers for Disease Control reported in 2014. More than 16 million have a health condition related to smoking.

    To Be Eligible For Medicaid To Cover The Medication You Must:

    Tobacco Cessation Coverage in Medicaid: What You Need to Know
    • Be at least 18 years of age.
    • You and your provider must complete the Nebraska Tobacco Quitline Fax Referral Form .
    • Enroll and actively participate in the Nebraska Tobacco Free Quitline.
    • Complete the intake and first counseling session with the Quitline Coach.
    • Visit your provider:
    • You must be checked to make sure side effects from the medications won’t put you at risk.
    • You will need a prescription for the medications.
    • You can talk to your provider about this during another office visit. Or, you can schedule a visit just to talk about smoking cessation.

    Contact Nebraska Total Care for additional information. Our phone number is 1-844-385-2192 .

    Also Check: Can You Work And Get Medicaid

    Insurance Type: Grandfathered Health Plans

    Who’s Covered?

    Individuals enrolled in a plan that was in existence before March 2010 and has not made significant changes since

    Required Coverage

    No requirements, but plans may opt to cover tobacco cessation treatment

    Cost-sharing: money a patient must pay when receiving treatment/filling a prescription: copays, coinsurance, deductibles, etc.

    Medicare Coverage For Smoking Cessation

    Most people associate cigarette smoking with lung disease. But many dont realize that smoking causes harm throughout the entire body in many different ways. Smoking doesnt just cause people to die sooner. 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.

    Recommended Reading: Does Sunrise Assisted Living Accept Medicaid

    Medicares 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.

    Medicare smoking cessation counseling can help you:

    • 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.

    Popular

    More like this
    Related

    How Do I Sign Up For Pregnancy Medicaid

    Can Uninsured...

    Eyeglass Places That Accept Medicaid

    Confirm Medicaid...

    How To Find My Medicaid Id Number

    When Will...