Tobacco use can quickly lead to an addiction to tobacco. Not only is tobacco use expensive, but it can impact your health negatively and even causes incredibly severe health problems down the line. Many adults may want to quit independently but quickly discover they could use assistance.
When you’re ready to quit smoking, you make a life-changing decision. And sometimes, that decision can be challenging, and you can use additional help and resources to make it happen. Thankfully, Medicare is here to help you with this process.
Let’s continue below to find out how Medicare coverage of smoking cessation works so that you can successfully quit smoking.
What Is Smoking Cessation?
Smoking cessation is best known as the overall process of quitting smoking. Quitting tobacco isn’t necessarily the easiest thing to accomplish on your own, so that’s why Medicare believes in providing smoking cessation programs. The CDC reports that in 2018, only 7.5% of adults (around 2.9 million) who smoked cigarettes successfully quit smoking within a year.
Since it can be challenging on your own, Medicare offers smoking sensation counseling sessions as a fully covered service. When you decide to quit smoking, you take back your life. Life expectancy can increase, your sense of smell and taste can return, your health can take a turn for the better, and more.
Does Medicare Cover Smoking Cessation?
Medicare considers smoking cessation a preventative service, a covered service through your Part B benefits. Each year you use tobacco, Part B will cover two smoking cessation counseling sessions.
Each session comprises four appointments with your physician, so you’ll ultimately receive eight appointments within 12 months with your doctor if you wish. With Medicare Part B benefits, you’ll need to pay your annual deductible of $240 in .
But since smoking cessation therapy is covered at 100%, you won’t need to worry about meeting the deductible before receiving these sessions.
What Happens In Smoking Cessation Counseling Sessions
When you attend smoking cessation counseling sessions, your doctor can work with you to create strategies to quit smoking effectively. You and your healthcare provider can discuss specific triggers that may push you to smoke, help identify alternatives to smoking, such as exercising or taking on a new hobby, and can help discuss different options to help cope with withdrawal symptoms.
Between you and your provider, you’ll develop a strategy to help overcome the cravings to smoke and may find that you’re far more successful with the support of a physician.
Requirements For Medicare Coverage For Smoking Cessation
The Medicare program considers smoking cessation to be a form of preventative care. Medicare covers preventive services at the total cost, meaning you and your provider won’t need to prove that a service or treatment is medically necessary for you to get services covered.
You will need to receive Original Medicare to qualify, but since it’s covered at 100%, you won’t need to worry about meeting your deductible before receiving coverage for these counseling sessions. To qualify, you must be a regular tobacco user and visit a doctor who’s in-network with Medicare.
Medicare Part D Coverage of Smoking Cessation
Part D helps to cover a select few prescription medications to help with smoking cessation. And while some health insurance plans may help cover over-the-counter medications at a drug store, Part D benefits won’t. Some of the most common prescriptions that Part D covers are:
- Varenicline (Chantix)
- NRT inhalers
- Zyban
- NRT nasal spray
You’ll want to check your prescription drug plan to ensure your specific prescribed medications are covered and determine how much you can expect to pay out-of-pocket.
Nicotine Replacement Therapy Costs
Nicotine replacement therapy costs vary. Many times, you may pay nothing out-of-pocket, depending on the medication. Other times, you’ll find that drugs such as Chantix could be anywhere from $1 to $9, depending on your prescription drug plan.
And when comparing a Part D prescription drug plan to a Medicare Advantage plan, you’ll find that they’re usually pretty comparable. Either way, additional financial assistance can help ease the burden f medical bills when it’s time to fill a prescription, whether for smoking cessation or other health conditions.
FAQs
What Smoking Cessation Medications Aren’t covered by Medicare?
Since only prescription medications are covered through Part D benefits, you’ll need to pay out-of-pocket for any smoking cessation aids available over the counter. Nicotine replacement therapy is incredibly popular among smokers who wish to quit.
Using these products allows small amounts of nicotine to enter your body to help alleviate the withdrawal symptoms of eliminating tobacco immediately. Some of the most popular over-the-counter smoking cessation products available are:
- Nicotine inhalers
- Nicotine patches
- Nicotine gum
- Nicotine lozenges
Just because Original Medicare doesn’t cover these nicotine products doesn’t necessarily mean that Medicare Advantage policies won’t. Medicare Advantage policies may offer a generous discount or at least minimal insurance coverage to help pay for over-the-counter medications.
How Much Does Medicare Pay For 99406?
Medicare will cover smoking cessation (ICD-10 code 99406) at 100% of the cost. Smoking cessation is covered because Medicare considers smoking cessation to be a preventative service. So, you won’t need to pay a coinsurance amount, copays, or worry about meeting your deductible before receiving coverage for this service.
One thing to remember when searching for providers to administer your smoking cessation sessions is that your provider will need to be contracted with Medicare and accept the Medicare assignment. Otherwise, you’ll need to foot the entire bill out-of-pocket.
How Do Providers Bill Medicare For Smoking Cessation?
Medicare covers two cessation attempts within 12 months. So that means that Medicare beneficiaries get to visit with a provider for up to eight sessions each year (ICD-10 99407). Providers use the following codes for smoking cessation:
- 99406 – Providers use this for smoking cessation sessions that are considered intermediate and are longer than three minutes long but no more than ten minutes long.
- 99407 – Providers use this code for smoking cessation sessions that are deemed intensive and last more than minutes.
Requirements For Medicare Coverage For Smoking Cessation
The Medicare program considers smoking cessation to be a form of preventative care. Medicare covers preventive services at full cost, meaning you and your provider won’t need to prove that a service or treatment is medically necessary for you to get services covered.
You will need to receive Original Medicare to qualify, but since it’s covered at 100%, you won’t need to worry about meeting your deductible before receiving coverage for these counseling sessions. To qualify, you must be a regular tobacco user and visit a doctor who’s in-network with Medicare.
What Is The Medicare Reimbursement For ICD-10 Code 99406 and 99407?
Medicare Part B’s reimbursement for ICD-10 Code 99406 is $15.70. This session is three to ten minutes long. The reimbursement for code 99407 is $28.96. This session is a session that lasts longer than ten minutes.
Where Can I Find More Information About Medicare Coverage For Smoking Cessation?
Tobacco cessation counseling is a great tool when quitting nicotine. You can find out even more information about smoking cessation by visiting the following informative websites:
Get Help With Medicare for Smoking Cessation
Smoking is expensive and unhealthy, so why not start saving some of that money while you protect your health? Medicare Supplement plans can help you with the expense of coinsurance, copayments, and more.
Our team can compare the best policies and find the best Medicare options available in your area. Complete our online form here for an instant quote, or call us at your convenience.
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