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Coverage for Smoking Cessation Treatments Called Inconsistent, Confusing

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Although the Affordable Care Act (ACA) requires new private health plans to cover several methods of tobacco cessation, many insurance plans are not providing mandated coverage to help smokers quit, a new report concludes.

Researchers at Georgetown University’s Health Policy Institute found consumers trying to receive coverage for smoking cessation treatment often ran into confusing language and inconsistent rules, Kaiser Health News reports.

They examined 39 insurance contracts in six states, including federal, state, small-group and individual policies. They found while 36 contracts stated they covered tobacco cessation or provided coverage consistent with government guidelines, 26 also entirely or partially excluded tobacco cessation from coverage.

The report found wide variation in coverage for cessation counseling and medication, indicating treatments required under the ACA are not being covered. Only four of the 39 plans said they covered individual, group and phone counseling, as well as prescription and over-the-counter medications. Many of the policies excluded certain types of counseling, and did not provide any coverage of medications for tobacco cessation. Some policies included cost-sharing requirements, in apparent conflict with the law. The ACA requires full coverage of preventive services.

“It is shocking to see the huge variation in what appears to be a straight forward inexpensive benefit that has significant medical evidence on treatment that works,” lead researcher Mila Kofman said in a news release. “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.”

“Insurance companies that are not covering smoking cessation are truly penny wise and pound foolish,” said Matthew Myers, President of the Campaign For Tobacco Free Kids, which commissioned the report. “Our hope is that the study will be a wake-up call for those trying to implement the Affordable Care Act.”

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