Cessation Treatment Coverage | American Lung Association
 
  • Share this page:

Cessation Treatment Coverage

The cessation treatment coverage criteria used in the American Lung Association's "State of Tobacco Control 2017" report are based on the coverage of tobacco cessation treatments provided by the federal government through its four main public insurance programs:

  1. Medicare (for Americans over age 65)
  2. Medicaid (for low-income and/or disabled Americans)
  3. TRICARE (for members of the military and their families)
  4. Federal Employee Health Benefits Program (for federal employees and their families).

A fifth category was added in "State of Tobacco Control 2013" to cover federal requirements for tobacco cessation treatment coverage in state health insurance exchanges under the Patient Protection and Affordable Care Act or health care reform law. Providing help to quit through these programs and state health insurance exchanges will reach large numbers of tobacco users, improve health, prevent unnecessary death, save taxpayer money and set an example for other health plans. The federal government must lead by example and cover a comprehensive benefit for everyone to whom it provides healthcare.

The definition of a comprehensive tobacco cessation benefit used in these criteria follows the recommendations in the Clinical Practice Guideline entitled Treating Tobacco Use and Dependence. In this Guideline, the U.S. Public Health Service recommends the use of seven medications and three types of counseling as effective for helping tobacco users quit.

The cessation coverage grade breaks down as follows:

Grade

Points Earned

A

18 to 20 Total Points

B

16 to 17 Total Points

C

14 to 15 Total Points

D

12 to 13 Total Points

F

Under 12 Total Points

Medicare (4 points)

Target is all Medicare recipients have easy access to a comprehensive cessation benefit.

  • +4 points: All Guideline-recommended medications and counseling are covered.
  • +3 points: At least 4 medications and 1 type of counseling are covered.
  • +2 points: At least 2 medications and 1 type of counseling are covered.
  • +1 point: AAt least 1 treatment is covered.
  • +0 points: No coverage.

Medicaid (4 points)

Target is all Medicaid enrollees have easy access to a comprehensive cessation benefit.

  • +4 points: All Guideline-recommended medications and counseling are required to be covered.
  • +3 points: At least 4 medications and 1 type of counseling are required to be covered.
  • +2 points: At least 2 medications and 1 type of counseling are required to be covered.
  • +1 point: At least 1 treatment is required to be covered.
  • +0 points: No required coverage.

TRICARE (4 points)

Target is all TRICARE enrollees have easy access to a comprehensive cessation benefit.

  • +4 points: All Guideline-recommended medications and counseling are covered.
  • +3 points: At least 4 medications and 1 type of counseling are covered.
  • +2 points: At least 2 medications and 1 type of counseling are covered.
  • +1 point: At least 1 treatment is covered.
  • +0 points: No coverage.

Federal Employee Health Benefits (FEHB) (4 points)

Target is all federal employees and dependents have easy access to a comprehensive cessation benefit.

  • +4 points: All Guideline-recommended medications and counseling are covered.
  • +3 points: At least 4 medications and 1 type of counseling are covered.
  • +2 points: At least 2 medications and 1 type of counseling are covered.
  • +1 points: At least 1 treatment is covered.
  • +0 points: No coverage.

Federal Requirements for State Health Insurance Exchanges

Target is all plans in exchanges cover a comprehensive tobacco cessation benefit.

  • +4 points: All Guideline-recommended medications and counseling are covered.
  • +3 points: Guidance released outlining coverage of a comprehensive tobacco cessation benefit as a preventive service.
  • +1 point: At least 1 recommended tobacco cessation treatment is required to be covered.
  • +0 points: No coverage is required, or regulation is not published.

Bonus Points: 1 bonus point in each category is awarded if coverage is provided with minimal barriers to access.

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.

What is LUNG FORCE?

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.