Study cites confusion in stop-smoking plans

WASHINGTON — Most people who smoke want to quit, and the 2010 health care law is supposed to make it easier for them by requiring many insurance plans to cover smoking-cessation treatments with no out-of-pocket cost to members. But a recent study found that details about what is covered and who pays for it remain confusing and inconsistent.

‘‘We were taken aback at the extent to which the policies were rife with confusing language, conflicting coverage, and gaps in coverage,’’ said Matthew Myers, president of the Campaign for Tobacco-Free Kids, an advocacy group that commissioned the study.

The Affordable Care Act requires plans that are new or those whose coverage has changed enough to lose their grandfathered status to provide preventive benefits recommended by the US Preventive Services Task Force, without any cost-sharing by members.


The task force, a group of specialists that evaluates medical evidence to guide consumers’ and doctors’ decisions about screening and preventive services, strongly recommends tobacco-cessation treatment for adult smokers.

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It describes several effective treatments, such as counseling (including brief behavioral counseling sessions and phone quit lines) and medication (including nicotine-replacement gum, lozenges, and patch, as well as prescription nonnicotine drugs such as Zyban and Chantix).

It says research shows that a combination of counseling and medication is more effective at helping people quit than either type of treatment alone.

But when researchers at Georgetown University’s Health Policy Institute examined 39 health plans in six states, they found that coverage for smoking cessation was often confusing. Many contracts did not clearly state that the coverage was available, did not cover recommended treatments, or did not provide it without cost-sharing.

‘‘The study points out the need for the Department of Health and Human Services to provide much more specific guidelines,’’ Myers says.


Insurers offer a different perspective. ‘‘The final rules [for preventive services] recognized that there wasn’t necessarily a one-size-fits-all approach,’’ said Susan Pisano, a spokeswoman for America’s Health Insurance Plans, a trade group. ‘‘So we would expect to see variation around the methods that plans are using.’’

In addition, she said, her group’s own survey of plans found that nearly all offer some type of intervention for tobacco users.

Tobacco use kills an estimated 443,000 people in the United States every year, accounting for about one in five deaths annually. It remains the number one cause of preventable death.

If insurance coverage of smoking-cessation treatment is not enough to encourage people to quit, the health law provides an added incentive: Smokers’ premiums can be up to 50 percent higher than nonsmokers’ in some plans.

The Obama administration recently proposed softening that rule by allowing smokers to avoid the higher rate if they join a stop-smoking program.


Most studies have found that health insurance coverage increases both the use of stop-smoking treatments and the rates of smoking cessation, according to the 2008 clinical practice guideline on treating tobacco use and dependence published by the Department of Health and Human Services.

But even if comprehensive benefits are available, people will not use them if they don’t know about them, specialists say.