Powered by Q1Group LLC
Education and Decision Support Tools for the Medicare Community


Medicare Expands Coverage of Tobacco Cessation Counseling

Category: General Medicare
Published on 2010-08-27 13:37:35


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 [] 








Medicare Supplements
fill the gaps in your
Original Medicare
1. Enter Your ZIP Code:
» Medicare Supplement FAQs




Pets are Family Too!
Use your drug discount card to save on medications for the entire family ‐ including your pets.

  • No enrollment fee and no limits on usage
  • Everyone in your household can use the same card, including your pets
Your drug discount card is available to you at no cost.




Tips & Disclaimers
  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
  • Medicare has neither reviewed nor endorsed the information on our site.
  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
  • We are an independent education, research, and technology company. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. We are not compensated for Medicare plan enrollments. We do not sell leads or share your personal information.
  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDP-Compare.com and MA-Compare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.