Affordable Care Act Coverage

Tobacco cessation interventions for adults have an “A” rating by the U.S. Preventive Services Task Force (USPSTF), mandating coverage of tobacco cessation treatment. This applies to both federal and state run marketplace plans.

 

Coverage includes both counseling and medications without cost-sharing (out of pocket expense to the patient). For those using tobacco products, at least 2 quit attempts per year are covered.

This includes:

  • Four tobacco cessation counseling sessions of at least 10 minutes each (individual, phone, or group) without prior authorization
  • 90 days of any FDA-approved tobacco cessation medication when prescribed by a healthcare provider without prior authorization
  • The 7 FDA-approved cessation medications include: Nicotine patch, gum, lozenge, nasal spray, inhaler, bupropion, and varenicline.

 

These recommendations are based on the 2008 Update of the Clinical Practice Guideline:
Treating Tobacco Use and Dependence (PHS)


ACA plans which do not provide this coverage are out of compliance.
More information can be found here.

Resources for Providers