Medicare expands coverage for tobacco counseling
The U.S. Department of Health and Human Services has expanded Medicare coverage of evidence-based tobacco cessation counseling.
Under the new coverage, any smoker covered by Medicare will be able to receive tobacco cessation counseling from a qualified physician or other Medicare-recognized practitioner who can work with him/her to help stop using tobacco.
Before the decision, Medicare had covered tobacco counseling only for individuals diagnosed with a recognized tobacco-related disease.
All Medicare beneficiaries will continue to have access to smoking-cessation prescription medication through the Medicare Prescription Drug Program (Part D).
The U.S. Centers for Disease Control and Prevention estimate that tobacco use is the cause about one in five deaths in the United States each year. It's estimated that between 1995 and 2015, tobacco-related diseases will cost Medicare about $800 billion.
Of the 46 million Americans who smoke, an estimated 4.5 million are Medicare beneficiaries 65 or older, and less than 1 million are younger than 65 and are covered by Medicare due to a disability.
The new Medicare benefit will cover two individual tobacco cessation counseling attempts per year. Each attempt may include up to four sessions, with a total annual benefit covering up to eight sessions per Medicare patient who uses tobacco.
The final coverage decision will apply to services under Parts A and B of Medicare and does not change the existing policies for Part D or any state-level policies for Medicaid or the Children's Health Insurance Program. HHS will issue guidance in the coming months about a new benefit for pregnant women to receive Medicaid-covered tobacco cessation counseling.
The new benefit, a provision of the Affordable Care Act, requires states to make coverage available to pregnant Medicaid beneficiaries by Oct. 1, 2010.
Under the Affordable Care Act, effective Jan. 1, 2011, Medicare will cover preventive care services, including tobacco cessation counseling services, and other services such as certain colorectal cancer screening and mammograms, at no cost to beneficiaries.
