Most people who smoke want to quit, and the 2010 health-care law is supposed to make it easier for them by requiring many insurance plans to cover smoking-cessation treatments with no out-of-pocket cost to members. But a recent study found that details about what’s covered and who pays for it remain confusing and inconsistent.
“We were taken aback at the extent to which the policies were rife with confusing language, conflicting coverage and gaps in coverage,” says Matthew Myers, president of the Campaign for Tobacco-Free Kids, an advocacy group that commissioned the study. The Affordable Care Act requires plans that are new or those whose coverage has changed enough to lose their grandfathered status to provide preventive benefits recommended by the U.S. Preventive Services Task Force without any cost-sharing by members.
The task force, a group of experts that evaluates medical evidence to guide consumers’ and doctors’ decisions about screening and preventive services, strongly recommends tobacco-cessation treatment for adult smokers. It describes several effective treatments, such as counseling (including brief behavioral counseling sessions and telephone quit lines) and medication (including nicotine-replacement gum, lozenges and the patch, as well as prescription non-nicotine drugs such as Zyban and Chantix). It says research shows that a combination of counseling and medication together is more effective at helping people quit than either type of treatment alone.
But when researchers at Georgetown University’s Health Policy Institute examined 39 health plans in six states, they found that coverage for smoking cessation was often confusing. Many contracts didn’t clearly state that the coverage was available, didn’t cover recommended treatments and/or didn’t provide it without cost-sharing.
“The study points out the need for the Department of Health and Human Services to provide much more specific guidelines,” Myers says.
Insurers offer a different perspective. “The final rules [for preventive services] recognized that there wasn’t necessarily a one-size-fits-all approach,” says Susan Pisano, a spokeswoman for America’s Health Insurance Plans, a trade group. “So we would expect to see variation around the methods that plans are using. Tobacco use kills an estimated 443,000 people in the US every year, accounting for about one in five deaths annually. It remains the No. 1 cause of preventable death.
If insurance coverage of smoking-cessation treatment isn’t enough to encourage people to quit, the health law provides an added incentive: Smokers’ premiums can be up to 50 percent higher than non-smokers’ in some plans. The Obama administration recently proposed soytening that rule by allowing smokers to avoid the higher rate if they participate in a stop-smoking program.Cited by Washington Post