Health Care Payors

The Patient Protection and Affordable Care Act (PPACA) is aimed at expanding access to health care and lowering cost barriers to seeking and receiving care, particularly high-value preventive care.

Coverage for Tobacco Cessation
Tobacco cessation must be provided at no cost under most types of health insurance as of January 1, 2014. However, there is no single definition of tobacco cessation so the scope of coverage is likely to vary by state, by type of insurance (e.g., Medicare, Medicaid, private insurance), and by the insurance provider (e.g., Aetna, Blue Cross, etc.)
For example, insurance may provide coverage for only some of the following elements:

  • Counseling: in-person (individual or group), via phone, or via the internet
  • Prescription cessation medications such as varenicline (Chantix) and buproprion (Zyban)
  • Over-the-counter nicotine replacement therapies (NRTs), such as nicotine patches or gum.

Because tobacco cessation treatment has received an “A” grade from the U.S. Preventive Services Task Force (USPSTF), most private insurance plans must provide such treatment at no costs. The most recent USPSTF ratings recommend both behavioral interventions (counseling) and FDA-approved cessation medications, including nicotine replacement therapy.

Return on Investment or “ROI” is an economic measure used to evaluate the efficiency of an investment. Attached is the ROI for tobacco cessation.

NH Tobacco Helpline Services, Benefits & Costs of a Partnership Agreement Q & A.