Report: State Health Insurance Marketplace Plans Could Help More Smokers Quit | American Lung Association

Report: State Health Insurance Marketplace Plans Could Help More Smokers Quit

(March 31, 2015)

If your health insurance plan covers quit-smoking treatments, you are more likely to try to quit and be successful. A new report from the American Lung Association, "State Health Insurance Marketplace Plans: New Opportunities to Help Smokers Quit," finds that the majority of health insurance plans and policymakers are not taking advantage of the chance to help millions of smokers quit.

State health insurance marketplace plans are required by the Affordable Care Act (ACA) to help smokers quit as a free essential health benefit. However, the overwhelming majority of state health insurance marketplace plans are not providing the coverage they should be for smoking cessation. Millions of Americans who have enrolled in health insurance marketplace plans should be provided with free tools to quit smoking, but as the new report shows, fewer than 20 percent of plan issuers are providing the appropriate coverage.

The report also shows that only 60 plan issuers out of 348 are covering tobacco cessation medications with no cost-sharing as required in the ACA. Fewer than half of the plan issuers list the seven approved cessation medications on their publicly available drug lists, or formularies. Only one state, West Virginia, had all plans in the marketplace covering all tobacco cessation medications. This is a bright note, but it's important to know that West Virginia has only one plan issuer selling plans in its marketplace.

What should plans cover?
According to the ACA and federal guidance, all plans should cover a comprehensive tobacco cessation benefit:

  • At least four sessions of individual, group and telephone cessation counseling
  • All FDA-approved tobacco cessation medications (nicotine patch, gum, lozenge, nasal spray and inhaler; bupropion and varenicline)
  • At least two quit attempts per year
  • No cost-sharing, like copays, coinsurance or deductibles
  • No prior authorization requirements.

The majority of marketplace plans are not only falling short of the guidelines set by the federal government, but more importantly, they are also missing a critical opportunity to help millions of Americans quit smoking. Evidence also suggests that smoking rates of people enrolled in marketplace plans are high, which means that they are missing the chance to offer full cessation benefits to those who may need it the most.

"Quitting is hard and the Lung Association knows that making sure everyone has access to all quit smoking medications and counseling is critical to saving lives," said Harold Wimmer, President and CEO of the American Lung Association. "Federal and state policy makers must make sure insurance plans are covering a comprehensive cessation benefit with no-cost sharing. Not only will it save lives, but it is also the law. State and federal policymakers should step in to ensure plans are following requirements."

Tobacco use is the number-one preventable cause of disease and death in the United States, and is responsible for almost 500,000 deaths each year. Tobacco use costs our country over $289 billion annually in smoking-related healthcare expenses and lost productivity. Almost 70 percent of smokers want to quit.

Ready to quit?
For anyone who is ready quit or is ready to help someone else quit, the American Lung Association has tools and tips you need. Our Freedom From Smoking® program is available in an in-person group setting or online. Our Freedom From Smoking® Helpline (1-800-LUNGUSA) is staffed with smoking cessation experts who can get you started on a quit plan, answer your questions and help you on the path to becoming tobacco-free. Calls are toll-free at 1-800-LUNGUSA.

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