Most people who smoke want to quit, and the 2010 health-care law is supposed to make it easier for them by requiring many insurance plans to cover smoking-cessation treatments with no out-of-pocket cost to members. But a recent study found that details about what’s covered and who pays for it remain confusing and inconsistent.
“We were taken aback at the extent to which the policies were rife with confusing language, conflicting coverage and gaps in coverage,” says Matthew Myers, president of the Campaign for Tobacco-Free Kids, an advocacy group that commissioned the study.
The Affordable Care Act requires plans that are new or those whose coverage has changed enough to lose their grandfathered status to provide preventive benefits recommended by the U.S. Preventive Services Task Force without any cost-sharing by members.
The task force, a group of experts that evaluates medical evidence to guide consumers’ and doctors’ decisions about screening and preventive services, strongly recommends tobacco-cessation treatment for adult smokers. It describes several effective treatments, such as counseling (including brief behavioral counseling sessions and telephone quit lines) and medication (including nicotine-replacement gum, lozenges and the patch, as well as prescription non-nicotine drugs such as Zyban and Chantix). It says research shows that a combination of counseling and medication together is more effective at helping people quit than either type of treatment alone.
But when researchers at Georgetown University’s Health Policy Institute examined 39 health plans in six states, they found that coverage for smoking cessation was often confusing. Many contracts didn’t clearly state that the coverage was available, didn’t cover recommended treatments and/or didn’t provide it without cost-sharing.
“The study points out the need for the Department of Health and Human Services to provide much more specific guidelines,” Myers says.
Tobacco use kills an estimated 443,000 people in the United States every year, accounting for about one in five deaths annually. It remains the No. 1 cause of preventable death.
If insurance coverage of smoking-cessation treatment isn’t enough to encourage people to quit, the health law provides an added incentive: Smokers’ premiums can be up to 50 percent higher than non-smokers’ in some plans. The Obama administration recently proposed softening that rule by allowing smokers to avoid the higher rate if they participate in a stop-smoking program.
As is often the case, knowledge is power
Most studies have found that health insurance coverage increases both the use of stop-smoking treatments and the rates of smoking cessation, according to the 2008 clinical practice guideline on treating tobacco use and dependence published by the Department of Health and Human Services.
But even if comprehensive benefits are available, people won’t use them if they don’t know about them, say experts. “Information is critical,” says Mila Kofman, a research professor at Georgetown University’s Health Policy Institute and the lead author of the recent study about coverage details.
If a health plan’s materials simply say that its members have coverage for preventive benefits, “they may not understand that it includes tobacco-cessation treatment and that they have that for free.”