The U.S. Department of Health and Human Services expanded Medicare coverage of evidence-based tobacco cessation counseling, removing a barrier to treatment for all tobacco users covered by Medicare.
Before [the August 25, 2010] decision, Medicare had covered tobacco counseling only for individuals diagnosed with a recognized tobacco-related disease or showed signs or symptoms of such a disease. 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 them to help them stop using tobacco. All Medicare beneficiaries will continue to have access to smoking-cessation prescription medication through the Medicare Prescription Drug Program (Part D).
"For too long, many tobacco users with Medicare coverage were denied access to evidence-based tobacco cessation counseling," said Secretary Kathleen Sebelius. "Most Medicare beneficiaries want to quit their tobacco use. Now, older adults and other Medicare beneficiaries can get the help they need to successfully overcome tobacco dependence."
"[The August 25, 2010] decision builds on the existing preventive services that are available to Medicare beneficiaries," said CMS Administrator Don Berwick, M.D. "Giving older Americans and persons with disabilities who rely on Medicare the coverage they need for counseling treatments that can aid them in quitting will have a positive impact on their health and quality of life. As a result, all Medicare beneficiaries now have more help to avoid the painful—and often deadly—consequences of tobacco use."
Tobacco use remains the leading cause of preventable illness and death in the United States and is a major contributor to the nation’s increasing medical costs. The U.S. Centers for Disease Control and Prevention estimate that tobacco use causes about one of five deaths in the United States each year and that, on average, adults who use tobacco die 14 years earlier than non-users. It is estimated that between 1995 and 2015, tobacco-related diseases will cost Medicare about $800 billion.
Despite the expansive list of adverse effects caused by tobacco use, and smoking in particular, about 46 million Americans continue to smoke. Of these, 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. For smokers who successfully quit, the health benefits will begin immediately and continue for the rest of their lives. These benefits include reducing their risk of death from coronary heart disease, chronic obstructive lung disease, and lung and other cancers.
The new benefit will cover two individual tobacco cessation counseling attempts per year. Each attempt may include up to four sessions, with a total annual benefit thus covering up to eight sessions per Medicare patient who uses tobacco.
[The August 25, 2010] 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. This new benefit, a provision of the Affordable Care Act, requires states to make coverage available to pregnant Medicaid beneficiaries by October 1, 2010.
"We know that older adults and other Medicare beneficiaries can be successful in their struggles to stop using tobacco, as long as they have the right resources available to them," said Assistant Secretary of Health Howard Koh, M.D., M.P.H. " [The August 25, 2010] decision will assure that beneficiaries can access that help from qualified physicians and other Medicare-recognized practitioners."
Under the Affordable Care Act, effective Jan. 1, 2011, Medicare will cover preventive care services, including the tobacco cessation counseling services provided under [the August 25, 2010] decision, and other services such as certain colorectal cancer screening and mammograms at no cost to beneficiaries. The Affordable Care Act also gives beneficiaries access to a no-cost annual physical exam so they can partner with their doctors to develop and update personal prevention plans, which will be based on their current health needs and risk factors.
Source: Centers for Medicare and Medicaid Services with editorial changes as noted in