The U.S. Department of Health & Human Services has expanded Medicare coverage of evidence-based tobacco cessation counseling, removing a barrier to treatment for all tobacco users covered by Medicare.  

Before this decision, Medicare had covered tobacco counseling only for individuals diagnosed with a recognized tobacco-related disease or showed signs or symptoms of such a disease. Under the new coverage, any smoker covered by Medicare will be able to receive tobacco cessation counseling from a qualified physician or other Medicare-recognized practitioner who can work with them to help them stop using tobacco. All Medicare beneficiaries will continue to have access to smoking-cessation prescription medication through the Medicare Prescription Drug Program (Part D).

Tobacco use remains the leading cause of preventable illness and death in the United States and is a major contributor to the nation's increasing medical costs. The Centers for Disease Control & Prevention estimate that tobacco use causes about one of five deaths in the United States each year and that, on average, adults who use tobacco die 14 years earlier than non-users. It is estimated that between 1995 and 2015, tobacco-related diseases will cost Medicare about $800 billion.

Despite the expansive list of adverse effects caused by tobacco use, and smoking in particular, about 46 million Americans continue to smoke. Of these, an estimated 4.5 million are Medicare beneficiaries 65 or older and less than 1 million are younger than 65 and are covered by Medicare due to a disability.  For smokers who successfully quit, the health benefits will begin immediately and continue for the rest of their lives. These benefits include reducing their risk of death from coronary heart disease, chronic obstructive lung disease, and lung and other cancers.

The new benefit will cover two individual tobacco cessation counseling attempts per year. Each attempt may include up to four sessions, with a total annual benefit thus covering up to eight sessions per Medicare patient who uses tobacco.

Today's final coverage decision will apply to services under Parts A and B of Medicare and does not change the existing policies for Part D, or any state-level policies for Medicaid or the Children's Health Insurance Program. HHS will issue guidance in the coming months about a new benefit for pregnant women to receive Medicaid-covered tobacco cessation counseling. This new benefit, a provision of the Affordable Care Act, requires states to make coverage available to pregnant Medicaid beneficiaries by Oct. 1.

Under the Affordable Care Act, effective Jan. 1, 2011, Medicare will cover preventive care services, including the tobacco cessation counseling services provided under this decision, and other services such as certain colorectal cancer screening and mammograms at no cost to beneficiaries. The Affordable Care Act also gives beneficiaries access to a no-cost annual physical exam so they can partner with their doctors to develop and update personal prevention plans, which will be based on their current health needs and risk factors.