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Assessing Coverage

The first step is to consider how insured covered lives are distributed across several classes of public and private or commercial insurance in each state. The next step is to “piece together” or estimate which insured populations have access to cessation benefits and where gaps exist either in coverage or information about cessation coverage. 

Comprehensive cessation benefits have been legislatively-mandated by legislatures in some states for Medicaid or commercial insurance. In other states, educational and media initiatives have been undertaken to influence employers to offer cessation benefits. However substantial numbers of insured individuals in some states may be participating in federal programs (e.g. Medicare, Federal employees, Veterans Administration, or Military) and are not subject to state policy action.

Here are some questions to consider:

  • What proportion of the state’s population has public or private health insurance? Of the “covered lives in your state, what proportion participate in:
    • Federal programs like Medicare and Federal employee insurance, the Veterans Administration or the Department of Defense (Tricare) for active military personnel?
    • State Medicaid programs? Of these, what proportion participates in Medicaid Managed Care Plans
    • Other fully or partially subsidized insurance, such as Commonwealth Care in Massachusetts?
    • State employee or state retiree insurance plans
    • Employer or union sponsored plans? Of these, what proportion is self-insured? How many employers have purchased comprehensive barrier-free cessation benefits? Carved them out? Offer cessa
  • Which of these groups and plans offer comprehensive, barrier-free coverage?

 Next: Status of Insurance Coverage across States

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