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

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.mass.gov 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.
• 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.

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.