Does Medicare Cover Smoking Cessation?

We all know that smoking is terrible for us. It’s a habit that damages almost every organ in the human body, causes 90% of lung cancer deaths, and can lead to other chronic conditions like heart disease, stroke, and emphysema. Despite overall declines in smoking, tobacco use is still one of the leading causes of preventable death in the U.S., according to data from the Centers for Disease Control and Prevention (CDC). 

Yet, knowing all that doesn’t make quitting easy, especially after you’ve been addicted for decades.  

Surveys of U.S. adults conducted in 2011 and in 2022 found that the percentage who smoked cigarettes went down in every age group … except for those over 65. However, research shows that no matter how old you are or how long you’ve smoked, you’re still likely to improve your quality of life and lower your risk of premature death by quitting. 

Most U.S. adults who are 65 or older get their health insurance either through the Original Medicare program administered by the federal government or a Medicare Advantage plan from a private insurance carrier. Your health coverage can provide access to services, treatment, and resources that may help you ditch the cigs for good. 

Why Many Smokers Struggle To Quit 

In 2018, the National Health Interview Survey found that, while over 55% of adult smokers had tried to quit at some point that year, less than 8% were successful. Quitting is extremely difficult because smoking has become an important part of your daily routine and can cause intense cravings. 

When you stop using nicotine, you may experience withdrawal symptoms such as: 

• Anxiety 
• Depression 
• Irritability 
• Restlessness 
• Lack of concentration 
• Trouble sleeping 
• Weight gain

These feelings might have stopped you from quitting in the past. But the right support and medical care can empower you to find your way through them. 

Medicare Coverage for Smoking Cessation Counseling 

A good place to start your journey to a life without cigarettes is at the doctor’s office. Medicare Part B, the part of Original Medicare for outpatient medical services, covers counseling sessions with a healthcare provider to help you stop using tobacco — up to four sessions per attempt to quit and up to two attempts per year. 

If you’re on Medicare Part B and see a doctor who accepts assignment (meaning they take the Medicare-recommended amount as full payment), these sessions cost you nothing out of pocket. Medicare Advantage plans, which substitute for Original Medicare, match this coverage, but you may need to see a doctor in your plan’s provider network. 

During these sessions, you’ll discuss your history of tobacco use and current habits to inform a plan for quitting. This conversation may involve: 

• Setting a date to quit within the next month. 
• Deciding what medication (or combination of medications) would be the best choice to help you. 
• Planning how you will cope with withdrawal symptoms through strategies like exercising, calling a friend, and chewing gum.  
• Considering what situations and locations might trigger you to light up — such as taking breaks during the day with other people who smoke — and finding ways to avoid them if possible. 
• Discussing where you can find support aside from your doctor, like through a state quitline (1-800-QUIT-NOW; 1-855-DÉJELO-YA), a program in your community, or online (Smokefree.gov; CDC.gov/quit; becomeanex.org). 

Using Over-the Counter Benefits for Nicotine Replacement Therapy 

When you’re trying to stop using tobacco, you need all the help you can get. A variety of medications can make quitting smoking easier than going cold turkey. 

Nicotine replacement therapy (NRT) is a common approach, in which you use low doses of the addictive drug in tobacco, minus the hundreds of other harmful chemicals in cigarette smoke. Taken over a period of several weeks, the nicotine can minimize your cravings and withdrawal symptoms. 

Over-the-counter nicotine replacements are sold in a few forms: 

• Gum: Available with either two or four milligrams of nicotine per piece, you slowly chew this gum and position it in your cheek to absorb the nicotine. 
• Lozenges: These work like the gum, but you slowly dissolve them in your mouth over a period of 20-30 minutes. They’re also available in either two or four milligram strengths. 
• Patches: You can choose from patches containing seven, 14, or 21 milligrams of nicotine. Most people wear a patch all day, lowering the dose over time. 

Any of these options may work best for you, based on your personal tobacco use and preferences. 

Some Medicare Advantage plans provide benefits to help pay for over-the-counter items, often including nicotine replacements. The details depend on your plan, but many provide a prepaid debit card that you can use to purchase approved items at a drugstore or online. 

Smokers who are looking for an alternative to cigarettes sometimes choose e-cigarettes, also called vaping. These devices do cause you to inhale fewer toxic chemicals than a traditional cigarette. However, medical experts are still concerned about their possible impact on your health and don’t consider them an effective way to fight addiction.  

How Your Prescription Drug Coverage Can Help You Quit Smoking  

With a prescription, you can access a range of stop-smoking aids beyond the options available over the counter. Some of these are additional nicotine replacement therapies: Either a nicotine inhaler or a nicotine nasal spray works quickly to manage sudden cravings and can be combined with other products. 

Otherwise, a doctor may prescribe one of two non-nicotine drugs, both taken as tablets by mouth: 

• Varenicline, marketed under the name Chantix, changes the way your brain reacts to nicotine so smoking no longer feels as good. For smokers who have struggled to quit with nicotine replacements, this medication works differently and may get better results. 

• Bupropion is an antidepressant that’s been found to help people stop smoking. The formulation created for smoking cessation is marketed as Zyban. With a doctor’s supervision, this drug can be combined with a nicotine patch, but, because of side effects, it’s prescribed less often than other smoking cessation drugs. 

If you’re on Original Medicare, you need to enroll in a Medicare Part D prescription drug plan from a private insurance carrier to get help paying for these medications. Most Medicare Advantage plans include Part D coverage. Coverage details and costs vary by plan, so it’s a good idea to check what you can expect to pay for a supply of a specific stop-smoking aid. 

Almost 16 million Americans live with chronic obstructive pulmonary disease (COPD), usually caused by smoking, which leads to more and more severe breathing problems. If you have COPD, you may have access to certain Medicare Advantage plans that can provide help with getting coordinated treatment and additional benefits. Talk to a licensed insurance agent about whether there’s a chronic condition special needs plan (C-SNP) available in your area that fits your needs. 

At any age, quitting smoking is one of the best things you can do for your overall health and quality of life. By seeking help and using the full range of benefits from your healthcare coverage, you can improve your chances of making a clean break from cigarettes. 

About GoHealth 

GoHealth is a leading health insurance marketplace and Medicare-focused digital health company. Enrolling in a health insurance plan can be confusing for customers, and the seemingly small differences between plans can lead to significant out-of-pocket costs or lack of access to critical medicines and even providers. GoHealth combines cutting-edge technology, data science, and deep industry expertise to build trusted relationships with consumers and match them with the healthcare policy and carrier that is right for them. Since its inception, GoHealth has enrolled millions of people in Medicare plans and individual and family plans. For more information, visit GoHealth.com.