Public health insurance quit-smoking coverage

Public health insurance plans provide health insurance at a lower cost for eligible individuals, children, families, seniors, and people with disabilities. In Massachusetts, public health plans include MassHealth (Medicaid), Commonwealth Care, and Medicare.

Each of the Massachusetts public health plans offers coverage for quit-smoking medicines and counseling. Look at the listings below to get more details about which benefits are covered.

Private health plans, HMOs, or other plans provided through employers also offer quit-smoking benefits, but coverage varies, so be sure to check with your plan.

 

MassHealth and Commonwealth Care

MassHealth pays for health care for certain low- and medium-income people living in Massachusetts, including a program for individuals who are HIV positive. To see if you might qualify for MassHealth, call 1-888-665-9993 or visit www.mass.gov/masshealth. 

Commonwealth Care connects uninsured Massachusetts residents with affordable health insurance. To qualify, your income must be less than 300% of the federal poverty level and you must meet other requirements. Learn more at www.mass.gov or call 1-877-MA-ENROLL.

Stop-smoking Medicines

MassHealth and Commonwealth Care cover stop-smoking medicines for your usual co-pay.

• nicotine patch
• nicotine gum
• nicotine lozenge
• pill (bupropion or Chantix)

Counseling

• MassHealth and Commonwealth Care cover counseling for free or for your usual co-pay.

• Boston Medical Center HealthNet Plan: Call 1-800-792-4355 or visit online at www.bmchp.org.
• CeltiCare Health Plan of Massachusetts: Call 1-866-895-1786 or visit online at www.celticarehealthplan.com.
• Fallon Community Health Plan: call 1-800-868-5200 or visit online at www.fchp.org.
• Neighborhood Health Plan: Call 1-800-462-5449 or visit online at www.nhp.org.
• Network Health: Call 1-888-257-1985 or visit online at www.network-health.org.

 

Medicare  

Medicare is a health insurance program for people age 65 or older and people under age 65 with certain disabilities. For more information call Medicare customer service at 1-800-MEDICARE (English and Spanish) or visit www.medicare.gov.

Stop-smoking Medicines

Medicare covers these FDA-approved prescription medications. No prior authorization is required.

• bupropion
• Chantix
• nicotine inhaler
• nicotine nasal spray

Supplemental Insurance Coverage:

• If you are covered by MassHealth in addition to Medicare, MassHealth will cover the nicotine patch, nicotine gum, and nicotine lozenge. No prior authorization is required. Your usual co-pay applies.
• For other supplemental insurance coverage, check with your insurer.

Counseling

Medicare covers counseling for two quit attempts per year, a maximum of four sessions per quit attempt.

• Counseling must be provided by a qualified doctor or other Medicare-recognized practitioner.

If you have not been diagnosed with a condition caused by smoking, Medicare will pay the full allowable amount and you will have no out-of-pocket cost.

If you have been diagnosed with or exhibit symptoms of a tobacco-related disease, you are responsible for co-pay, co-insurance and unmet deductible.