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Tobacco Cessation Report Lights Up Coverage Gaps, Confusing Language

Researchers found 'significant variation in how private health insurance coverage works for tobacco cessation treatment' when analyzing 39 insurance contracts in six states.

January 11, 2013

Many health insurers are not offering members free tobacco cessation treatment as required under the 2010 federal health reform law, according to a new report from Georgetown University's Health Policy Institute.

Other insurers offering the benefit don't make it clear to members that it is available to them, and some other policies put up barriers to members to participate in programs to help them quit smoking, according to the report.

Researchers found "significant variation in how private health insurance coverage works for tobacco cessation treatment" when analyzing 39 insurance contracts in six states. The contracts included individual, small group and state and federal employee benefit plans.

"It is shocking to see the huge variation in what appears to be a straightforward inexpensive benefit that has significant medical evidence on treatment that works," said Mila Kofman, principal author of the report and former Maine Superintendent of Insurance. "It is even more disappointing to find that some in the insurance industry are trying to avoid covering tobacco cessation treatment as required by the Affordable Care Act."

The Patient Protection and Affordable Care Act required health plans and employers to cover tobacco cessation treatment with no cost sharing to members starting with new plans in September 2010. In 2014, individual and small group plans must include preventative and wellness services such as smoking cessation as part of essential benefits under the law.

Tobacco is the leading cause of preventable death in the United States, killing more than 400,000 people annually and costing $193 billion each year in direct medical costs and productivity losses. Studies have shown that cessation programs do help people quit smoking and participation rates are higher when there's no co-payment, co-insurance or other cost sharing.

A 2006 report by Millman found that annual employer medical and life insurance claims drop by $192 per worker who quits smoking, for instance.

Among the shortcoming of the 39 contracts studied in the Georgetown study:

  • 15 contracts did not cover prescription drugs that have shown to help individuals quit smoking.
  • 24 contracts excluded over the counter medications to help quit tobacco.
  • Only four contracts included as a covered benefit individual counseling, phone counseling, group counseling, prescription drugs and over the counter medications.
  • Seven the contracts required cost-sharing for counseling by in-network providers
  • Six of the 24 contracts that covered prescriptions for quitting smoking required cost-sharing
  • One contract required individuals to fill out a health risk assessment to access prescriptions and over the counter medications for tobacco cessation

"Covering effective tobacco cessation treatments is a smart way for insurers to avoid the cost of future illness, and it is the law," said Matthew Myers, president of the Campaign for Tobacco-Free Kids, which funded the study.

The report authors recommend that regulators require insurers to communicate clearly to members their policies on tobacco cessation treatment and also provide insurers guidance on limitations to coverage under the law.

Report is here: http://www.tobaccofreekids.org/pressoffice/2012/georgetown/coveragereport.pdf

Rebecca Vesely is a writer based in San Francisco. Comment below or email editors@workforce.com.