Across the Northeast, Health Insurance Marketplace Plans Among the Majority Nationally that Fail to Offer Required Quit Smoking Coverage, New Report Reveals | American Lung Association

Across the Northeast, Health Insurance Marketplace Plans Among the Majority Nationally that Fail to Offer Required Quit Smoking Coverage, New Report Reveals

(March 31, 2015)

The overwhelming majority of state health insurance marketplace plans are not providing the coverage they should be for smoking cessation. The state plans across the Northeast are no exception with major holes in tobacco cessation coverage in every state from New York to Maine. Millions of Americans who have enrolled in health insurance marketplace plans should be provided with free tools to quit smoking, but a new report from the American Lung Association shows fewer than 20 percent of plan issuers nationwide are providing the appropriate coverage. 


State health insurance marketplace plans are required by the Affordable Care Act (ACA) to help smokers quit as a free essential health benefit. The new concludes that the vast majority of these plans are falling short.


The report shows that only 60 plan issuers out of 348 (17 percent) nationwide are covering tobacco cessation medications with no cost-sharing as required in the Affordable Care Act, and fewer than half of issuers list those seven approved cessation medications on their publically available drug lists, or formularies. Only one state, West Virginia, had all plans in the marketplace covering all tobacco cessation medications. West Virginia has only one plan issuer selling plans in its marketplace.


Of the 46 plans offered in states across the Northeast, only 5 insurance plans are in full compliance with ACA guidance.


“Marketplace plans across our region are not only falling short of the guidelines set by the Affordable Care Act, but more importantly, they are also missing a critical opportunity to help residents quit smoking,” said Jeff Seyler, President and CEO of the American Lung Association of the Northeast. “Evidence suggests that smoking rates of people enrolled in marketplace plans are high, which means that we are missing the chance to offer full cessation benefits to those who may need it the most.”


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.


“Helping smokers quit is proven to save lives and money. At the Lung Association, we know that quitting is hard. That’s why we’re fighting to make sure everyone has access to all quit smoking medications and counseling to help them quit for good,” Seyler said. “It’s important that our state and federal policy makers  make sure all insurance plans get the job done, by covering a comprehensive cessation benefit with no-cost sharing.”


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.


Ask An Expert

Questions about your lung health? Need help finding healthcare? Call 1-800-LUNGUSA.

Get help
We need your generous support

Make a difference by delivering research, education and advocacy to those impacted by lung disease.


LUNG FORCE unites women and their loved ones across the country to stand together in the fight against lung cancer.

Get involved
Join the fight for healthy lungs and healthy air.
Donate Now.