I want to quit smoking. Can I get help through Medicare?
Yes you can. Medicare covers counseling to help you quit smoking. As of Aug. 25, 2010, Medicare covers smoking cessation for all people with Medicare, regardless of whether or not they have a disease or condition caused by smoking. Medicare will cover two counseling attempts at quitting smoking per year. Each attempt includes four sessions. Medicare will cover a total of eight sessions every 12 months.
Medicare will pay 80 percent of the approved amount for smoking cessation efforts after the deductible is met. For hospital outpatient department programs, you will have a co-pay that is no larger than the Part D deductible. If you are in a Medicare private health plan, contact your plan to see what rules and costs apply.
Starting Jan. 1, 2011, if you have Original Medicare, and if you have not been diagnosed with an illness that is caused or complicated by smoking, you will pay no co-insurance or deductible for smoking cessation counseling. If you have a smoking-related illness, however, you will still need to pay the Medicare co-insurance or co-pay and deductible.
Prescription drugs for smoking cessation are covered under the Medicare prescription drug benefit, Part D.
You can receive counseling at the doctor’s office from a physician, psychologist or clinical social worker; at a clinic; or at an outpatient department of a hospital. Counseling must be done by a doctor or an approved Medicare provider. Medicare will not pay for hypnosis sessions to help you quit smoking.
I am a former military service member and have good drug coverage through TRICARE. Should I still enroll in Medicare Part D?
It depends. TRICARE coverage is more comprehensive than Medicare’s drug coverage. You may be better off keeping your TRICARE and not enrolling in the Medicare drug benefit. If you decide you want to enroll in the Medicare drug benefit later, you will not have to pay a penalty as long as you enroll within 63 days of dropping or losing this coverage. Contact TRICARE for more information.
Note that if you qualify for full Extra Help, your co-pays for covered drugs may be less than if you just kept TRICARE. However, TRICARE’s list of covered drugs could be broader than those of Medicare private drug plans in your area, and TRICARE will cover drugs not on its list for a higher co-pay.
If you have TRICARE and you decide to join a Medicare private drug plan, Medicare will pay first and TRICARE will pay second.
My father is considering entering a nursing home. He has Medicare and Medicaid. Which will pay for his care?
While Medicare covers some skilled nursing facility care, it will only cover this care for a limited amount of time, up to 100 days in a benefit period if you meet certain criteria. If your father does not meet Medicare’s requirements for the skilled nursing facility benefit or has reached Medicare’s limit of covered skilled care, Medicaid may pay for this care.
All states have a Nursing Facility Medicaid program that provides general health coverage plus coverage for nursing home services. These services include room and board, nursing care, personal care and therapy services. Nursing Facility Medicaid may pay for a stay in a nursing home if you need a “nursing-home level of care” or meet “functional eligibility” criteria and if your income and assets are below certain guidelines. Different states have different standards for determining whether you need a nursing-home level of care.
Marci’s Medicare Answers is a service of the Medicare Rights Center, the nation’s largest independent source of information and assistance for people with Medicare.