Quitting smoking is worth it. You're worth it.
What does your insurance plan cover?
Many HMOs and other health insurance plans help cover the cost of quitting smoking. Not all plans cover both medication and support (also known as counseling).
Members of any health plan may also be referred by their health care provider to free telephone-support available through the QuitWorks fax-referral program. Any resident of Massachusetts may also receive information and stop-smoking support for free from the state’s Smoker’s Helpline at 1-800-Try-to-STOP.
Health plan coverage often changes, so you should call your insurance company to find out what kind of benefits you have that can help you quit smoking.
Click here for some questions to ask your insurance company.
Over 100 health insurance companies serve the residents of Massachusetts. Here is a list of some of the largest health plans in MA, including Medicaid and private insurers, with general information about how they help smokers quit.
Note: This information is meant to give you a basic idea of what your insurance might cover. Because benefits can change over time, and vary by product and employer, you should call your insurance company to get up-to-date information about your benefits. The information on this page is current as of November 15, 2007.
MassHealth (Medicaid)
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.
- Medications covered: The nicotine patch, gum, lozenge, and prescription medicines (including Chantix or Zyban, which is also known as bupropion) are covered, with a $1 or $3 co-pay. Ask your primary care provider for all the choices.
- Counseling support covered: MassHealth covers individual face-to-face and group counseling to help you quit smoking or chewing tobacco. Ask your MassHealth primary care provider about counseling to quit smoking.
- Which members are covered: MassHealth Standard, CommonHealth, Prenatal, and Family Assistance for Persons with HIV. People who have direct coverage (not premium assistance) for MassHealth Basic, MassHealth Essential, or Family Assistance for Children are also covered.
- For more information: Visit www.mass.gov/masshealth or call (800) 841-2900. If you are a MassHealth member of BMC HealthNet Plan, Fallon Community Health Plan, or Network Health, call their customer service line. Neighborhood Health Plan members should call (617) 204-1447 for information, including the availability of local in-person support programs.
Commonwealth Care
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.macommonwealthcare.com or call 1-877-MA-ENROLL.
- Medications covered: The nicotine patch, gum, lozenge, and prescription medicines (including bupropion or Chantix) are covered, with a co-pay. Fallon Commonwealth Care members may receive the patch or gum for free with counseling. Contact the member services number on your card to learn about co-pay amounts.
- Counseling support covered: Four insurance companies provide Commonwealth Care coverage, and each has different ways of providing support:
- Neighborhood Health Plan offers telephone support in English and Spanish; other languages are also available. There is no time limit for quit-smoking support; each member is treated on a case-by-case basis. Call (617) 204-1447 for information about in-person support in your area.
- Fallon Community Health Plan offers group sessions and telephone counseling.
- BMC HealthNet Plan offers the exact same benefit as MassHealth; see above.
- Network Health covers 12 outpatient mental health visits each year; these can be used for getting support to stop smoking. There is a $10 co-pay per visit for members with Plan Type II and IV, and a $20 co-pay per visit for members with Plan Type III. Call 1-888-257-1985 for more information.
- Neighborhood Health Plan offers telephone support in English and Spanish; other languages are also available. There is no time limit for quit-smoking support; each member is treated on a case-by-case basis. Call (617) 204-1447 for information about in-person support in your area.
- Which members are covered: All Commonwealth Care members receive some type of quit-smoking benefit. Contact your plan’s member services for details.
- For more information: Call your Commonwealth Care plan’s customer service line to ask about your specific benefit. The four Commonwealth Care plans are:
- Neighborhood Health Plan: Call 1-800-462-5449 or visit online at www.nhp.org.
- Fallon Community Health Plan: call 1-800-868-5200 or visit online at www.fchp.org.
- BMC HealthNet Plan: Call 1-800-792-4355 or visit online at www.bmchp.org.
- Network Health: Call 1-888-257-1985 or visit online at www.network-health.org.
- Neighborhood Health Plan: Call 1-800-462-5449 or visit online at www.nhp.org.
Medicare
Medicare is a health insurance program for people age 65 or older and people under age 65 with certain disabilities.
- Medications covered: Medicare Part D covers smoking cessation treatments prescribed by a physician. However, over-the-counter treatments, such as nicotine patches or gum, are not covered.
- Counseling support covered: Some cessation counseling is covered, up to 8 sessions per year. Talk with Medicare customer service for details.
- Which members are covered: To be eligible to receive this benefit, you must be a Medicare member who has a condition that is affected by smoking or tobacco use, or your smoking or tobacco use must affect the way your body reacts to a medication you are taking. Talk to your doctor to see if you qualify.
- For more information: Call Medicare customer service at 1-800-MEDICARE (English and Spanish). For general information about Medicare, visit www.medicare.gov. For information about Medicare’s quit-smoking benefit, go to www.cms.hhs.gov/SmokingCessation.
Private Health Insurance
Blue Cross Blue Shield
- Medications covered: Medications covered: Most Blue Cross Blue Shield of Massachusetts pharmacy plans cover nicotine replacement therapy (NRT) products, such as a nicotine patch, nicotine gum, and prescriptions like Zyban and Chantix. Coverage depends on individual benefit design and all applicable co-payments apply. To use your pharmacy benefit for smoking-cessation products (including over the counter aids), you should contact your doctor for a prescription. If you have questions about your pharmacy coverage, call Member Service at the number on your ID card from more information.
- Counseling support covered: Blue Cross Blue Shield encourages members to use 1-800-TRY-TO-STOP. The multi-session telephone counseling service has experienced counselors who will help set a date, prepare for quitting, and give helpful advice and support along the way. It also provides educational materials to those not quite ready to quit but working towards quitting. The service is provided by the MA Department of Public Health. www.trytostop.org is the online version of this program. Blue Cross Blue Shield of Massachusetts’ members can use MyBlueHealth through Member Self Service (MSS) on www.bluecrossma.com to access a variety of online wellness programs and resources including Ready Set Stop, a 6-week online smoking cessation module. The program reflects the latest clinical practice guidelines and relies heavily on the core principles of behavior change. Members and non-members can also use the smoking and tobacco resource center, an online resource with information to support you as you quit.
- Which members are covered: Drug benefit coverage depends on your individual benefit design.
- For more information: Ask your plan administrator or call Member Service at the phone number on your ID card for more information about your plan benefits. Visit Blue Cross Blue Shield’s website and click on "Living Healthy Smoke Free" at the bottom of the page.
Fallon Community Health Plan
- Medications covered: All Fallon Community Health Plan members can receive nicotine replacement therapy (NRT) products, such as a nicotine patch or nicotine gum, for $10/week. MassHealth members receive the patches (or gum) for free. Prescriptions to help stop smoking are covered for most members with commercial plans. Members participating in FCHP MassHealth or Fallon’s Commonwealth Care type 1 plan should contact their Customer Service Department (1-800-868-5200 or TDD/TTY: 1-877-608-7677) with questions on prescription drug coverage.
- Counseling support covered: Quit to Win, FCHP’s tobacco treatment program, offers support meetings where they will help you develop a personalized stop-smoking plan. Group counseling (support) sessions are available in four locations: Auburn, Leominster, Spencer, and Worcester. Phone counseling is also available.
- Which members are covered: All members receive the counseling and NRT benefit. Prescription coverage varies by plan. If you are a MassHealth or Commonwealth Care member, your benefit may be different; see information at the top of this page.
- For more information: To learn more about your stop-smoking options and coverage, call (508) 368-9540 or (888) 807-2908, or email Tobacco.Program@fchp.org. More information is available online at www.fchp.org.
Harvard Pilgrim
- Medications covered: Harvard Pilgrim Health Plan covers prescription stop-smoking medicines for members with prescription coverage. These covered medicines may include nicotine replacement therapy such as the nicotine patch (by prescription) and prescription medicines such as Zyban (bupropion) or Chantix (varenicline). Pharmacy co-pays apply with annual limitations.
- Counseling support: Harvard Pilgrim’s website has information about quitting smoking and lists support groups and classes. Visit www.harvardpilgrim.org.
- Which members are covered: Benefits vary based on individual plans. Contact Harvard Pilgrim Health Plan’s member services for information about your benefits.
- For more information: To learn more about your plan benefits, call member services at (888) 333-4742. You can email member services from Harvard Pilgrim’s contact page or browse their website for more information, at www.harvardpilgrim.org.
Health New England
- Medications covered: Members with a pharmacy benefit have coverage for nicotine patches, Zyban (90 days per 12 months), bupropion, Wellbutrin, and Chantix (60 tabs per 30 days, with a 90-day maximum per 12 months). A prior authorization (prescription) is required to receive this coverage.
- Counseling support covered: Health New England will pay $50 towards a cessation (quit smoking) program for members with asthma, diabetes, cardiovascular disease, or who are pregnant. For more information and to obtain a voucher for a cessation program, call 413-787-4000 or 800-842-4464 ext. 3553. Some community-based support programs are listed at www.healthnewengland.com/healthydirections
- Which members are covered: Members with a pharmacy benefit qualify for medication coverage. Members with asthma, diabetes, cardiovascular disease, or who are pregnant qualify for the quit smoking voucher. Benefits vary based on individual plans. Contact Health New England’s member services for information about your benefits.
- For more information: To learn more about your stop-smoking benefit, call 413-787-4000 or 800-842-4464 ext. 3553. More information is available online at www.healthnewengland.com.
Neighborhood Health Plan
- Medications covered: Neighborhood Health Plan covers stop-smoking medicines for members with prescription coverage. These covered medicines may include nicotine replacement therapy such as the nicotine patch or gum, and prescription medicines such as Zyban (bupropion) or Chantix (varenicline). Pharmacy co-pays apply.
- Counseling Support covered: Neighborhood Health Plan offers free expert counseling on the phone or in-person for up to 90 days for its members; no prescription or referral is needed to participate.
- Which members are covered: All members are eligible for free expert support (counseling). Members with prescription coverage are eligible for medication benefits. If you are a MassHealth or Commonwealth Care member, your benefit may be different; see information at the top of this page.
- For more information: To learn more about your plan benefits, call (617) 204-1447 or (800) 433-5556, extension 1447 anytime Monday through Friday from 8:30 a.m. to 4:30 p.m. You can also email QuitSmoking@nhp.org. More information is available at www.nhp.org.
Tufts Health Plan
- Medications covered: Members with a pharmacy benefit may be reimbursed for stop-smoking prescription medications, such as Chantix and Zyban Bupropion, if they can show proof of participation in a quit-smoking program. Coverage is limited to a maximum of a 12-week supply. Members also receive 40% off over-the-counter nicotine replacement therapy (NRT) products, such as a nicotine patch or nicotine gum, when they buy them online at www.HealthyRoads.com.
- Counseling support covered: All Tufts Health Plan members receive 30% off smoking cessation (quitting) classes offered at participating hospitals. Present your Tufts Health Plan ID card when you register. A list of participating hospitals that may offer quit smoking classes is located at www.tuftshealthplan.com.
- Which members are covered: Benefits vary based on individual plans. Contact Tufts Health Plan’s member services for information about your benefits.
- For more information: For more information about your HMO, EPO, or POS plan benefits, contact member services at (800) 462-0224. For more information about your PPO plan benefits, contact member services at (800) 423-8080.
Some questions to ask your insurance company are:
- Is medication covered by my insurance?
- If so, are prescriptions covered?
- If so, are over-the-counter medications like the nicotine patch covered?
- Is there a limit to the amount of medication that is covered?
- What is the co-pay?
- Is counseling (support) to quit smoking covered by my insurance?
If the answer is yes, some questions to ask are:- Is group counseling covered?
- Is one-on-one in-person counseling covered?
- Are local quit-smoking services available?
- Is there a limit to the amount of counseling that is covered?
- Is there a co-pay or reimbursement for services used?
- Are other types of support covered (for example, hypnotherapy and acupuncture)?
