Medicare Coverage for Smoking Cessation

Smoking cessation services fall under Medicare Part B, which covers a variety of preventive services.

You’re covered for up to two attempts at quitting each year. Each attempt includes four face-to-face counseling sessions, for a total of eight covered sessions per year.

Along with counseling, your doctor might recommend prescription medications to help you quit smoking. Medicare Part B doesn’t cover prescriptions, but you can purchase this coverage with a Medicare Part D (prescription drug) plan. A Part D plan will help you cover these costs.

You can get these services under a Medicare Advantage plan too. Medicare Advantage plans, also known as Medicare Part C plans, are required to offer the same coverage as original Medicare.

Some Advantage plans also include prescription drug coverage, as well as additional smoking cessation help that original Medicare doesn’t cover.

During counseling sessions to help you stop smoking, a doctor or therapist will give you personalized advice on how to quit. You’ll get help with:

• making a plan to quit smoking
• identifying situations that trigger your urge to smoke
• finding alternatives that can replace smoking when you have the urge
• removing tobacco products, as well as lighters and ashtrays, from your home, car, or office
• learning how quitting can benefit your health
• understanding the emotional and physical effects you might go through while quitting

You can get counseling in a few different ways, including by phone and in group sessions.

Phone counseling offers all the support of in-office sessions but you don’t have to leave your home.

In group sessions, counselors guide a small collection of people who are all working toward the same goal, such as quitting smoking. Group counseling can be a great way to get support from people who know what you’re going through and to share your successes and struggles.

The counselor you choose must be approved by Medicare if you want to have the services covered. You must also be a current smoker and be actively enrolled in Medicare. You can find providers in your area using the Medicare website.

How much does it cost?

The cost of your eight counseling sessions will be completely covered by Medicare as long as you use a Medicare-approved provider. Your only cost will be your Part B monthly premium (or the premium for your Medicare Advantage plan), but this will be the same amount you usually pay.

Your doctor may also prescribe a medication to help you stop smoking. These drugs help you quit by reducing your urge to smoke.

To qualify for coverage, the medication must be prescribed by your doctor and approved by the U.S. Food and Drug Administration (FDA) to help with smoking cessation. Currently, the FDA has approved two prescription options:

• Chantix (varenicline tartrate)
• Zyban (bupropion hydrochloride)

If you have a prescription drug plan through Medicare Part D or Medicare Advantage, you should be covered for these medications. In fact, any plan you have through Medicare is required to cover at least one medication for smoking cessation.

How much does it cost?

You can find generic forms of these medications, and they’re generally affordable.

The most common price for bupropion (the generic form of Zyban) is around $20 for a 30-day supply, even without insurance or coupons. This cost is what you may pay without insurance. The actual price you’ll pay depends on your insurance plan, your location, and the pharmacy you use.

Your out-of-pocket cost will also depend on your specific Part D or Advantage plan. You can check your plan’s list of covered medications, known as a formulary, if you want to see which medications are included.

It’s also a good idea to shop around at participating pharmacies in your neighborhood for the best price.

Only prescription medications for smoking cessation are covered by Medicare. Over-the-counter products are not covered. So, even if they might help you quit smoking, you’ll need to pay for them out of pocket.

Some available over-the-counter products include:

• nicotine gum
• nicotine lozenges
• nicotine patches
• nicotine inhalers

These products are known as nicotine replacement therapy. Using them can help you quit gradually, because they allow you to get small doses of nicotine without actually smoking. This process can help you experience fewer withdrawal symptoms.

No matter which product you choose, the goal is to use it less as time goes on. This way, your body will adjust to less and less nicotine.

Original Medicare doesn’t cover any of these over-the-counter products.

If you have a Medicare Advantage plan, though, it might include some coverage or discounts on these products. You can check the details of your plan or search for one in your area that covers these products using Medicare’s plan finder.

The process of quitting smoking is known as smoking cessation. According to a survey by the CDC, approximately 68 percent of American adult smokers wanted to quit in 2015.

Reasons to quit smoking include:

• increased life expectancy
• decreased risk of many diseases
• overall health improvement
• improved skin quality
• better sense of taste and smell
• fewer colds or allergy symptoms

The cost of cigarettes is another factor that leads many people to quit. Research shows that quitting smoking can save you as much as $3,820 a year. Despite this, only 7.5 percent of smokers successfully quit in 2018.

If you’re trying to quit, smoking cessation methods can help you with the symptoms of nicotine withdrawal and give you the tools you need to stay smoke-free.

You can try many other methods in addition to counseling sessions, prescriptions, and over-the-counter productions.

For example, several smartphone apps have been designed to help you manage your cravings and find peer support. You may also find nontraditional methods, like acupuncture or herbal remedies, helpful.

Some people use e-cigarettes when trying to quit, but this method isn’t recommended.

Need help quitting?

Here are some additional resources for when you’re ready to take the next step:

• The National Network of Tobacco Cessation Quitline. This hotline will connect you with an expert who can help you make a plan to quit for good. You can call 800-QUITNOW (800-784-8669) to get started.
• Smokefree. Smokefree can direct you to resources, set up a chat with a trained counselor, and help you track your progress.
• Freedom from Smoking. This program, offered by the American Lung Association, has been helping people quit smoking since 1981.

Medicare can help you quit smoking. It covers several different types of programs.

As you decide which options are best for you, keep in mind that:

• Medicare considers smoking cessation preventive care.
• You can get eight smoking cessation counseling sessions fully covered each year, as long as your provider is enrolled in Medicare.
• You can get prescription drugs covered under Medicare Part D or Medicare Advantage.
• Original Medicare doesn’t cover over-the-counter products, but an Advantage plan might.
• Quitting smoking on your own can be difficult, but cessation programs, medications, and peer support can help.