Does Medicare Cover Chantix?
No matter how long you’ve been smoking, or how old you are, it’s never too late to kick the habit. Most people know that smoking is dangerous. It not only shortens your life, but it can cause a long list of diseases and health conditions, including:
- Lung diseases like chronic bronchitis or emphysema
- Heart disease
- Increased risk of certain types of cancer like lung, mouth, larynx, esophagus, stomach, bladder, cervical, or kidney cancers.
- Respiratory problems
- Eye disease like cataracts and age-related macular degeneration
- Erectile dysfunction
- And others
Tobacco contains nicotine, which is highly addictive, making it very hard to quit smoking without help. Because withdrawal symptoms are often quite severe and disruptive, many health care providers suggest taking a prescription medication like Chantix to help stop the cravings and withdrawal symptoms and help you quit smoking for good.
Does Medicare cover Chantix?
Chantix is the brand name for the generic drug called varenicline. Physicians typically prescribe Chantix in combination with behavior modification and counseling for patients who want help quitting smoking. If your Medicare-affiliated health care provider prescribes Chantix and certifies that it is medically necessary to treat your condition, you can get coverage through a Medicare Part D plan.
You can get prescription drug coverage through a stand-alone Medicare Part D plan if you have Original Medicare, or through a Medicare Advantage (Part C) plan that includes prescription drug coverage.
It is mandatory for all Medicare prescription drug plans to include at least one medication for smoking cessation on the plan formulary or list of covered drugs. However, all Part D plans are free to set copayment amounts, so how much you pay for your prescription of Chantix depends on the plan you are enrolled in.
How much does Chantix cost without insurance?
Without Medicare insurance coverage, Chantix can be expensive. Your cost depends on where you live and where you shop, but the national average price for a 12-week supply (that’s the recommended amount of time for the program) can run between $800 and $1,200. There are generic brands of Chantix that cost less, so if you do some research and discuss the differences with your health care provider, you might find a less expensive alternative to Chantix.
Medicare benefits for smoking and tobacco use cessation counseling
For Medicare beneficiaries who use tobacco, Original Medicare Part B (medical insurance) covers counseling programs to help them quit. Medicare Part B considers smoking cessation counseling as preventive care and covers 100 percent of the cost for up to eight smoking and tobacco use sessions during a 12-month period.
To be eligible for this benefit, you must be a current smoker, enrolled in Medicare Part B or Part C, and the counseling sessions must be run by a qualified physician or another Medicare-recognized health care provider.
Smoking cessation counseling sessions can take place over the phone or in-person groups. Your counselor gives you personalized help with the following:
- Creating a plan to quit tobacco use
- Finding your trigger situations
- Coming up with alternatives for smoking when cravings hit
- How to remove tobacco products and paraphernalia from your environment
- Education about how quitting benefits your health
- Recognizing the emotional and physical effects of quitting
Medicare beneficiaries who have coverage with a Medicare Advantage (Part C) plan are eligible for smoking cessation counseling sessions too. However, depending on your plan, you may have a coinsurance or copayment attached to these services. Your provider may also require that you use counselors who are included in the plan’s network of providers.
If you aren’t sure what restrictions your Medicare Advantage plan carries, you should call your provider to get details before you enroll in a counseling program.