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Does Medicare Cover Smoking Cessation Treatments?

Most smokers know that using tobacco products is bad for their health. Smoking is a leading cause of preventable deaths due to cancer and heart and lung diseases. Seniors with Medicare coverage may have been smoking for years, but the good news is it’s never too late to quit. Medicare provides beneficiaries access to smoking cessation treatments. Let’s take a closer look at how Medicare can support your quit-smoking goals.

Key takeaways:
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    No matter your age and how many years you spent smoking, quitting is one of the best choices you can make for your health. Medicare can help you reach your goals.
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    When used together, counseling and medication are beneficial, safe, and effective at making quitting and withdrawal symptoms more manageable.
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    Medicare prescription drug plans cover smoking cessation medications, including Chantix, Zyban, and nicotine inhalers.
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    Medicare Part B will cover eight counseling sessions every twelve months at no cost. Counseling sessions provide a personalized quit plan, advice, and actionable steps to combat triggers.

What is smoking cessation?

No matter your age and how many years you spent smoking, deciding to quit is one of the best choices you can make for your health. Some people successfully use a “cold turkey” method where they stop smoking without any aids such as counseling, nicotine replacement therapy, or prescription medications. However, others have found that smoking cessation treatments have finally led them to freedom and better health.

A few of the many health benefits of quitting smoking include:

  • Improved overall health and well-being
  • Reduced risk of heart attack and cardiovascular disease
  • Reduced respiratory infections like bronchitis and pneumonia
  • Reduced risk of type 2 diabetes and can improve blood sugars
  • Lowered risk of COPD
  • Enhances mood and mental health
  • Reduced risk of many cancers, including leukemia and colon cancer
  • Can improve outcomes for people already diagnosed with a chronic condition
  • Your doctor may be able to lower the prescribed dosages of certain medications
  • Not exposing others to secondhand smoke.
  • Financial benefits

According to the CDC, only about 7.5 % of adult smokers who attempted to quit in the year preceding 2018 were successful. Furthermore, only about a third of the 21.5 million people who made at least one attempt in 2018 took advantage of counseling services and FDA-approved medications. Luckily, Medicare provides a variety of coverage options to seniors, and you could join the 55 million adults who have managed to quit using tobacco products over their lifetime.

Does Medicare cover smoking cessation treatments?

Medicare knows that successfully quitting smoking can improve an individual’s overall health and finances. A healthier senior population makes less financial demands on the larger population and healthcare systems. So, as a result, Medicare started offering smoking cessation benefits in the 2000s. Benefits have continued to evolve to match updated treatments.

Quitting smoking is difficult because you need to learn how to go about your daily routine without tobacco, and your brain must learn to function without nicotine. A combination approach to quitting by using counseling and medication is beneficial but remains underused. Counseling benefits are covered under Medicare Part B, while prescription medications fall under drug coverage benefits. You will need to talk with your Medicare-approved provider about your best quit plan. Benefits may vary by your type of policy.

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Medicare coverage for smoking cessation medications

Medicare only covers prescription medications for smoking cessation, meaning your doctor must provide you with an order or prescription to get filled at the pharmacy. The drugs must be FDA-approved to qualify for coverage. Talking with your doctor will help determine the best approach for you. If you have tried unsuccessfully in the past, don’t give up; another method may work for you. Medications can alleviate withdrawal symptoms and make quitting easier.

Currently, most Medicare prescription drug plans cover the following prescription medications. They have been proven safe and effective for smoking cessation treatment.

Varenicline is commonly known as Chantix. It is a prescription pill that acts by blocking nicotine receptors in the brain, thereby reducing the urge to smoke. Covered under most Medicare drug plans, it is an expensive but popular treatment for smoking cessation. It does not contain nicotine.

Bupropion, also known as Zyban, is another non-nicotine pill to aid in smoking cessation. Typically covered by most Medicare drug plans, you begin taking this pill about 1-2 weeks before your quit date.

NRT Inhalers are devices that contain nicotine. NRT stands for nicotine replacement therapy. These drugs work similarly to over-the-counter NRT products designed to reduce nicotine cravings and reduce withdrawal symptoms. However, these medications are by prescription only. Inhalers taken by mouth are cigarette-shaped, while nasal sprays deliver medicine through your nostrils.

Although prescription medications are valuable, most providers recommend combining drug therapy with counseling for the best chance of success.

What do prescription medications cost?

Original Medicare Parts A and B do not cover prescription medications, so you must have drug coverage under Part D or Medicare Advantage. Since private insurance companies manage these plans, there may be differences in coverage, copays, deductibles, and covered drugs. You will, however, need a prescription from your healthcare provider before you can get any of the above medications. Talking with your health plan representative will help determine your out-of-pocket costs.

It is worth noting that prices can differ between pharmacies, and sometimes, mail-order pharmacies are cheaper. Online coupons or discounts may also lower costs.

Does Medicare cover counseling for smoking cessation?

Yes, Medicare Part B covers smoking cessation counseling as long as it is medically necessary. Counseling offers encouragement, advice, and actionable steps, helping smokers devise a personalized quit plan. Most providers encourage counseling because it has a higher success rate when combined with other treatments.

During counseling sessions, you can expect to:

  • Develop a personalized quit plan
  • Adjust the quit plan if necessary with expert guidance and support
  • Explore reasons for quitting to keep you on track
  • Learn new strategies for coping and maintaining your quit
  • Assess and identify triggers

To qualify for coverage, a Medicare-approved provider must facilitate the therapy sessions, and you will want to ensure they accept Medicare assignment.

Additional eligibility criteria include:

  • You must currently use tobacco products
  • You must be competent, alert, and oriented during therapy
  • You do not have to show signs or symptoms of a tobacco-related disease to qualify.

You can also choose counseling services that work best for you. You may get counseling services in person, group settings, or by phone. You can find local providers on the Medicare website.

How much will counseling cost?

Medicare views smoking cessation as preventive care because of the numerous health benefits. Therefore, they will cover eight counseling sessions every twelve months at no cost. You must be enrolled in Medicare Part B with a Medicare-approved provider or therapist. Beneficiaries are allowed four sessions per quit and two quit attempts per year. If unsuccessful, you can try again in the next twelve months. Ensure your provider accepts Medicare assignment to avoid unexpected costs.

Are there any smoking cessation products not covered by Medicare?

Medicare Part D will not cover over-the-counter smoking cessation medications. Over-the-counter medications do not require a person to have a doctor’s prescription before purchase. Besides the inhalers mentioned earlier, nicotine replacement products typically fall under this category. Medicare insurance does not cover nicotine patches, gum, and lozenges.

However, products like NicoDerm CQ patches and Nicorette gum have helped people quit smoking, and although not covered by Medicare insurance, they may support your efforts. If your physician recommends these products, shopping for the best price is a good idea. Additionally, Advantage plans may provide some coverage for OTC medications.

Does Medicare cover hypnotherapy for smoking cessation?

Hypnotherapy helps some smokers quit by reducing the impulse to smoke and increasing the desire to stop. Typically, Medicare insurance does not cover hypnotherapy for smoking cessation. However, some supplemental plans may offer this benefit. Talk with your doctor and plan representative for details regarding your specific benefits.

Quitting smoking leads to positive long-term health and financial benefits. But understandably, many smokers have concerns about managing short-term withdrawal symptoms. Do not let doubts deter you if you genuinely want to quit. Additionally, it can take smokers several quit attempts before it sticks. Withdrawal from tobacco products is very real, but remember that you are no different from the millions who have managed to quit successfully.

Whether you have used tobacco products for years, are a heavy or light smoker, or tried to quit unsuccessfully in the past, this time can be different. Healthcare providers can help you develop and maintain a personalized quit plan. By taking advantage of Medicare insurance coverage for smoking cessation medications and counseling, beneficiaries may get the support needed to live a longer, healthier life free from tobacco products.

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