MEDICAID
Your Medicaid health plan can provide additional benefits to help you quit tobacco allowing for repeated courses of treatment as long as they are consistent with FDA-approved use of medications.
Contact your health plan or review your member benefits handbook to determine any out of pocket cost such as deductible, co-payments or coinsurance.
Your Medicaid health plan covers the following FDA-approved medications:
- Nicotine gum
- Nicotine lozenge
- Nicotine inhaler
- Nicotine nasal spray
- Nicotine patch
- Bupropion SR (Zyban)
- Varenicline (Chantix)
- Combination therapy: Nicotine replacement therapy and Zyban; or nicotine patch and other nicotine replacement therapy
Each Medicaid health plan offers different counseling services. Call your health plan or review your membership package to learn what is covered.
Coverage for Pregnant Women
Medicaid also provides additional tobacco cessation coverage for women who are pregnant or who have given birth within the last 60 days. This includes four counseling sessions per quit attempt for up to two quit attempts per year.
MEDICARE
Medicare provides support in quitting tobacco, but depending on your health plan you may be responsible for part of the cost of the additional support.
Contact your health plan or review your member benefits handbook to determine any out of pocket cost such as, deductible, copayments or coinsurance.
Your Part D prescription drug plan or a Medicare Advantage plan should cover the following FDA-approved medications:
- Nicotine inhaler
- Nicotine nasal spray
- Bupropion SR (Zyban)
- Varenicline (Chantix)
Over the counter medications like nicotine gum or patches are not covered by Medicare.
Medicare covers up to eight in-person or group counseling sessions per year at 100% of the Medicare-approved amount when you receive the service from a participating provider. This means you pay nothing (no deductible or coinsurance).
Medicare Advantage Plans cover counseling without applying deductibles, copayments, or coinsurance when you see an in-network provider and meet Medicare’s eligibility requirements for the service.
PRIVATE HEALTH PLANS
Private health plans typically offer expanded quit services, such as NRT medications and counseling support. Call your health plan to see what services are covered under your plan.