Study: Health insurance plans not providing smoking cessation therapy pursuant to Affordable Care Act

WASHINGTON — Many health insurance plans are failing to provide coverage mandated by the healthcare reform law for treatments to help smokers and other tobacco users quit, the Campaign for Tobacco-Free Kids reported Monday, citing a study of insurance contracts by Georgetown University researchers that the group commissioned. 

"The [Patient Protection and] Affordable Care Act recognized that coverage for preventive care, including helping people quit tobacco, is a critical part of improving health and reducing healthcare costs in our country," stated Matthew Myers, president of the Campaign for Tobacco-Free Kids. "Covering effective tobacco cessation treatments is a smart way for insurers to avoid the cost of future illness, and it is the law."

The ACA requires all new private health insurance plans to cover preventive health services recommended with an A or B grade by the U.S. Preventive Services Task Force with no cost-sharing, such as co-pays. These recommendations include tobacco cessation treatments, which received an A grade. The USPSTF recommends that clinicians ask adults about tobacco use and provide cessation interventions for tobacco users. It found that more or longer counseling sessions improve quit rates, and combining counseling with medication is more effective for treating tobacco dependence than either therapy used alone.

To determine how the cessation coverage requirement is being implemented, insurance experts at the Georgetown University Health Policy Institute analyzed 39 health insurance plans sold in six states, including individual, small group, federal employee and state employee plans. The researchers found that many policies are rife with confusing and conflicting language that could leave consumers uncertain if tobacco cessation treatments are covered and discourage them from seeking these treatments. It also found that many policies included gaps in coverage for cessation counseling and medication and cost-sharing requirements that appear to conflict with the law.

For example, while 36 contracts indicated that they covered tobacco cessation or are providing coverage consistent with the USPSTF recommendations, 26 of these contracts also included language entirely or partially excluding tobacco cessation from coverage.

Only 4-of-39 plans stated they covered individual, group and phone counseling and both prescription and over-the-counter medications. Many policies specifically excluded certain types of counseling and provided no coverage of prescription and OTC medications for tobacco cessation.

And in apparent conflict with the law, some policies included cost-sharing requirements. Seven-of-36 contracts that clearly covered counseling required cost-sharing for counseling by in-network providers, and 6-of-24 contracts that covered prescription drugs required cost-sharing.

The study was commissioned by the Campaign for Tobacco-Free Kids with funding from Pfizer.

For the complete study, click here.