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Status of Coverage

There is wide variation in cessation benefits offered by commercial insurers, based on information available, and there are significant gaps in information, especially in the small and mid-size employer market. The American Lung Association collects data on cessation benefit coverage, including Medicaid, and produces a state-by-state report card. Click here for their most recent report, released on December 7, 2011.

ALA’s report contains the following overview:

  • Six states cover a comprehensive tobacco cessation benefit for all Medicaid enrollees: Indiana, Massachusetts, Minnesota, Nevada, North Carolina and Pennsylvania.
  • Two states do not cover any tobacco cessation treatments for all Medicaid enrollees: Alabama and Georgia.
  • Five states cover a comprehensive tobacco cessation benefit for all state employees: Illinois, Indiana, Maine, New Mexico and North Dakota.
  • Two states do not cover any tobacco cessation treatments for state employees: Louisiana and Marylan.d
  • Nine states require private insurance plans to cover tobacco cessation treatments: Colorado, Illinois, Maryland, New Jersey, New Mexico, North Dakota, Oregon, Rhode Island and Vermont.
  • Four states invest in quitlines at or above the recommended amount: Maine, North Dakota, South Dakota and Wyoming.

Private Insurance Information

There is no single or comprehensive source of information on private insurance coverage for tobacco cessation. Examples of the types of reports available are included in the Resources section and include the National Business Council on Health’s Evalue8 data for selected managed care plans and several state surveys. All show the variance in what private plans cover regarding tobacco cessation. Many plans do not offer comprehensive cessation benefits, as defined by the US Public Health Service Guideline. 

Medicaid Insurance Coverage by State

For a report of state-by-state Medicaid coverage for tobacco cessation, go to the American Lung Association’s  website.

Essential Health Benefits

 We urge states to include tobacco cessation services as an Essential Health Benefit and further to specify coverage detail, using the US Office of Personnel Management (OPM), Federal Employee Health Benefit Plan as a model. For information on the OPM cessation benefit, visit the OPM website

Next: Model Benefit Plan Coverage

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