The Affordable Care Act (ACA) and other federal laws and rules require most health insurance plans in the U.S. to cover some level of tobacco cessation treatments. The following chart gives details of these requirements. Note that information on this chart does not guarantee coverage for certain treatments in any insurance plan – policymakers and regulators must enforce these requirements and insurance plans and employers must implement them. Patients should check with their plan to confirm which treatments are covered.
Insurance Type: Medicare
Who's Covered?
Age 65+ or some disabled individuals
Required Coverage
- Cessation medications: nicotine nasal spray, nicotine inhaler, bupropion and varenicline. Part D plans may opt to cover other medications.
- 4 sessions of individual counseling
- Up to 2 quit attempts per year
- No cost-sharing for counseling
- Annual prevention visit
Insurance Type: Traditional Medicaid
Who's Covered?
Low-income or disabled individuals, eligibility varies by state
Required Coverage
For pregnant women:
- Individual, group and phone counseling
- All FDA-approved smoking cessation medications
For all Medicaid enrollees:
- All FDA-approved smoking cessation medications
Insurance Type: Medicaid Expansion
Who's Covered?
Low-income or disabled individuals, up to 138% of federal poverty level in states that expand Medicaid
Required Coverage
- Tobacco cessation as a preventive service. Federal guidance defines this as:
- 4 sessions of individual, group and phone counseling
- 90 days of all FDA-approved smoking cessation medications
- 2 quit attempts per year
- No prior authorization for treatments
- No cost-sharing
Insurance Type: State Health Insurance Marketplace Plans
Who's Covered?
Individuals who buy plans through healthcare.gov or their state’s marketplace. Subsidies for these plans are available to those earning 100-400% of the federal poverty level.
Required Coverage
- Tobacco cessation as a preventive service. Federal guidance defines this as:
- 4 sessions of individual, group and phone counseling
- 90 days of all FDA-approved smoking cessation medications
- 2 quit attempts per year
- No prior authorization for treatments
- No cost-sharing
Insurance Type: Employer-Sponsored Insurance
Who's Covered?
Individuals who receive health insurance through their employer, association, union or other organization.
Required Coverage
- Tobacco cessation as a preventive service. Federal guidance defines this as:
- 4 sessions of individual, group and phone counseling
- 90 days of all FDA-approved smoking cessation medications
- 2 quit attempts per year
- No prior authorization for treatments
- No cost-sharing
Insurance Type: Grandfathered Health Plans
Who's Covered?
Individuals enrolled in a plan that was in existence before March 2010 and has not made significant changes since
Required Coverage
No requirements, but plans may opt to cover tobacco cessation treatment
Cost-sharing: money a patient must pay when receiving treatment/filling a prescription: copays, coinsurance, deductibles, etc.
Insurance Type: Short-Term Limited-Duration Plans
Who's Covered?
These plans were designed to cover individuals to ill short gaps in health insurance coverage. They are plans sold on the individual market and have minimal federal regulations. These plans do not meet the Minimum Essential Coverage (MEC) standards as defined by the Affordable Care Act (ACA) and therefore are not legally considered to be health insurance plans. Short-term limited-duration plans do not satisfy the ACA’s individual mandate. Recently, the Department of Labor, Department of Treasury and the Department of Health and Human Services issued a new rule and starting October 2, 2018, short-term limited-duration plans can be sold for up to 364 days and can be renewable for up to three years.
Required Coverage
No requirements, but plans may opt to cover tobacco cessation treatment
Cost-sharing: money a patient may be required pay when receiving treatment/filling a prescription: copays, coinsurance, deductibles, etc.
Federal Poverty Level: a measure of income level issued annually by the federal government. These levels are used to establish eligibility for certain programs and benefits, including Medicaid and eligibility for subsidies for health insurance. For more information, visit https://www.healthcare.gov/glossary/federal-poverty-level-FPL/
Page last updated: November 17, 2022
