Medicare and Medicaid may cover certain tobacco cessation
interventions, ranging from reimbursement for tobacco cessation counseling or
to cover prescription or over-the-counter medications.
If patients present with tobacco-related health effects such
as cancers, heart disease, cough, bronchitis, and cataracts, you may be
reimbursed through Medicare for up to four 3- to 10-minute counseling sessions
or four sessions of 10 minutes or longer. These sessions can be as simple as
advising them to quit tobacco use and to take advantage of tools such as Ohio
Tobacco Quit Line.
The following summary outlines the latest in tobacco
cessation Medicare and Medicaid coverage provided through several Ohio health plans.
Additional information on Medicare and Medicaid services can be found at www.cms.hhs.gov.
Summary of Coverage
|
Coverage
|
Medicare
|
Medicaid
|
|
Intermediate Tobacco Cessation Counseling (3-10
minutes)
|
Up to four
sessions by a qualified physician or other Medicare-recognized practitioner
for a patient with a disease or adverse health effect recognized to be linked
to tobacco use.*
|
NA
|
|
Intensive Smoking Cessation Counseling (more
than 10 minutes)
|
Up to four
sessions by a qualified physician or other Medicare-recognized practitioner
for a patient with a disease or adverse health effect recognized to be linked
to tobacco use.*
|
NA
|
|
Individual Counseling
|
NA
|
Covered
|
|
Prescription smoking cessation medications
(Zyban®, nicotine inhaler and nasal spray)
|
Based on
individual health plan coverage.**
|
Ohio Medicaid
covers Nicotrol® inhalers and Zyban® with a prescription and $3 co-pay
|
|
Over-the-counter smoking cessation medications
|
No Coverage
|
Ohio Medicaid
covers Nicorette® Gum, Commit® Lozenges, Nicoderm® patches, and generic
nicotine patches only with a prescription and $3 co-pay
|
|
Group Therapy
|
No Coverage
|
No Coverage
|
|
Telephone or web-based counseling
|
No Coverage
|
No Coverage
|
* Examples of adverse health effects included
in the coverage are: cancers, heart disease, cough, bronchitis, and cataracts.
**In Ohio,
10 health plans cover Zyban® and
Nicotrol® Inhaler and 32 cover Zyban® or
Nicotrol® Inhaler.
|
|
