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Want to Quit Smoking? Medicare Can Help

Medicare provides a wide array of health care services for its enrollees. These include hospitalization through Part A, doctors’ services through Part B, and prescription drug coverage via Part D. Yet, while most people think of Medicare as offering the basics of medical needs, what many may not realize is that the programs also offers a lot more.

One such additional service is Medicare’s coverage for smoking and tobacco use cessation. This program includes counseling for Medicare enrollees to help them to stop smoking or with use of other types of tobacco products.

What is Covered Through Medicare’s Smoking and Tobacco Use Cessation?

All Medicare enrollees who use tobacco products are covered for the smoking and tobacco use cessation program. Through Medicare’s smoking and tobacco use cessation, Medicare Part B will cover two counseling attempts per year. Each of these counseling attempts includes a total of four counseling sessions. Medicare covers a total of eight counseling sessions every 12 months.

These covered visits must be provided via either a qualified doctor or other Medicare-recognized practitioner in order to qualify for coverage. Medicare will also cover smoking cessation counseling for those enrollees who have been diagnosed with a particular condition or disease that has been caused by smoking.

What Out-of-Pocket Costs are Involved?

For those who have Original Medicare (Medicare Parts A and B), there are no deductibles or coinsurance payments required for the counseling sessions if you have not been diagnosed with an illness that was either caused or complicated by smoking and you are seeing a doctor or provider who is recognized by Medicare.

If you have been diagnosed with an illness or condition that was caused by smoking, your smoking cessation counseling program may require you to pay 20 percent of the approved amount, while Medicare pays the other 80 percent, once the deductible has been met.  If you have a Medicare supplemental insurance plan then your plan may pick up the 20% for you.

Medicare smoking cessation programsYou may receive your smoking cessation counseling at a variety of places – including at a doctor’s office, a clinic, or an outpatient department at a hospital. Should you be receiving your counseling sessions within a hospital outpatient setting, you will be required to pay a copayment. This copayment amount will be no greater than the amount of the Medicare Part A deductible. In 2014, this deductible is $1,216.

Over-the-counter treatments for the cessation of smoking such as gum or patches are not covered by Medicare. This is because these items are excluded by law from Medicare Part D prescription drug coverage.

It is important to note that your doctor or other health care provider may recommend that you obtain services on a more frequent basis than what is covered by Medicare. Likewise, it is also possible that your doctor could recommend a service that is not covered by Medicare at all.

Should this be the case, you may be required to pay some or all of the expenses out-of-pocket. With this in mind, be sure to ask questions so that you fully understand exactly what is being recommended by your health care professional, and whether or not the cost will be covered by Medicare.

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