Many people are more successful in quitting smoking when they have the right support. Medicare helps pay for counseling and some medication for smoking cessation.
Individuals who smoke have a higher risk of many health complications. These can include heart disease, cancer, lung disease, and diabetes. Secondhand smoke may also promote lung disease and heart disease in adults. Medicare supports a person’s effort to quit smoking, as this may be beneficial to overall health.
A person is eligible for Medicare if they are aged 65 and older, or under 65 with specific health conditions. Original Medicare plans include coverage for both Part A, inpatient care, and Part B, outpatient services. Medicare smoking cessation coverage is normally available under Part B. Individuals with Medicare Part D may also receive coverage for certain smoking cessation drugs if they are on the formulary of their plan.
Glossary of Medicare terms
We may use a few terms in this article that can be helpful to understand when selecting the best insurance plan:
- Out-of-pocket costs: An out-of-pocket cost is the amount a person must pay for medical care when Medicare does not pay the total cost or offer coverage. These costs can include deductibles, coinsurance, copayments, and premiums.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before an insurer starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, this is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Individuals have coverage for smoking cessation through Medicare parts B, C, D, and Medigap. Generally, Medicare may cover smoking cessation medications and up to 2 quit attempts per year, with 4 sessions of individual counseling.
Counseling
Medicare Part B pays for up to eight counseling sessions, over a 12-month period.
A person does not pay for these visits if the provider accepts Medicare assignment. Medicare began paying for counseling services related to smoking in 2006.
There are many ways counseling may be beneficial, but most help a person:
- set a stop date
- develop a support group from friends and family
- learn relaxation skills
- learn how to control weight while quitting
- make a plan to deal with urges to smoke
- consider stop-smoking medications
Prescribed medication
Private insurance companies administer Medicare Part D plans. The plans cover drugs that are prescribed by a doctor.
At present, the U.S Food and Drug Administration (FDA) approves
They include the nicotine patch, nicotine gum, nicotine lozenge, nicotine nasal spray, and nicotine inhaler.
Medicare Part D drug plans do not cover over-the counter (OTC) medications. As such, they
A doctor can also prescribe two pill medicines that do not contain nicotine and help people stop smoking in other ways. They
- Bupropion: Also known as Wellbutrin or Zyban, this drug is helpful for reducing withdrawal symptoms, as well as helping to control the urge to smoke.
- Varenicline: Also known as Chantix, this prescription medication prevents the effects of nicotine if a person smokes, and can also help reduce the symptoms of withdrawal.
Both of these medications may be covered under a Part D plan, but it may be beneficial for a person to check the list of approved drugs, also known as a formulary, that their plan provider covers.
It is never too late for a person to quit smoking and improve their health, but there are some hurdles to overcome. Knowing what to expect may help an individual be better prepared.
Withdrawal symptoms
Nicotine is the main addicting drug in cigarettes. It affects the body and the brain. Over time the body gets used to having nicotine, and it must then readjust to not having the drug when a person quits. This is what causes withdrawal symptoms.
Smoking is an addiction, and quitting takes time. It can be helpful to have a plan in place in case withdrawal symptoms, and cravings begin. The American Lung Association states 4% to 7% of people who try to quit without a plan are successful.
Medicare stop-smoking counseling may help a person prepare a plan of support that could be needed during the most challenging parts of withdrawal.
Individuals may have the most cravings and withdrawal symptoms in the first week they quit. The urge to smoke usually slows down after the first week or ten days.
Weight gain
A person may gain weight while they are quitting smoking. One reason this happens is because eating is known to curb the urge to smoke.
The amount of weight a person usually gains is between 7 to 10 pounds, which according to the American Lung Association, does not have a great effect on health, if any.
Other challenges
A person may also experience some of the following symptoms during their quitting process:
- difficulty sleeping
- irritability
- feeling anxious
- restlessness
- difficulty concentrating
Medicare pays for services only if they are performed by a doctor or other approved healthcare provider, and they must accept assignment.
When a healthcare provider accepts assignment, it means they accept Medicare’s billing and costs.
A person may have out-of-pocket costs for programs to help quit smoking.
There is a monthly premium for Part B. The standard amount is $174.70, but may be higher depending on income.
Part B also has a deductible, which in 2024 is $240, and a coinsurance that is usually 20% of a billed amount.
Private insurance companies administer Medicare parts C, D, and Medigap plans. Due to this, an individual may pay a premium for these policies.
If a person does not have Medicare Part D, they may have to pay for medication out-of-pocket.
There are other options to help a person quit smoking, and often more than one program runs in a local area at one time.
An individual can investigate the options before choosing one that is right for them. People may find free programs through:
- employers
- private insurance companies
- local hospitals
- the local health department
Several national associations offer help lines, and some also offer local programs, depending on a person’s location.
- National Cancer Institute Quitline 877-448-7848
- American Cancer Society Quitline 800-227-2345
- American Lung Association Freedom From Smoking, with online and phone advice programs
- state programs can be found by calling 1-800-784-8669
SmokeFree.gov offers a unique way of growing a person’s support network through their social media platforms, including Facebook, Twitter, Instagram and Pinterest. Connecting with others may help a person get the support needed to stay smoke free.
Smoking increases the risk of heart disease, cancer, lung disease, and diabetes. Medicare helps pay for counseling and some prescription medications to quit smoking. Medicare parts B, C, D, and Medigap pay for treatment and services.
A person must use a provider approved by Medicare and they may have some out-of-pocket costs.
People may find support through programs in the community. Cancer and lung associations have helplines for advice to help stop smoking.
SmokeFree.gov has social media platforms where people may find support and network with others.