Are Nicotine Patches Covered by Medicare?
Understand how Medicare supports beneficiaries in their journey to quit smoking, detailing covered services and potential expenses.
Medicare, a federal health insurance program, provides coverage for millions of eligible individuals across the United States. Its primary function is to help manage healthcare costs for those aged 65 or older, and for certain younger people with disabilities. The program offers a framework for accessing various medical services, including preventive care aimed at promoting overall health and addressing common health challenges like tobacco use.
Medicare Coverage for Smoking Cessation Counseling
Medicare offers coverage for behavioral counseling services designed to help individuals stop using tobacco. These services are typically covered under Medicare Part B. Counseling is considered a preventive service, which can mean beneficiaries pay nothing out-of-pocket if certain conditions are met.
Medicare Part B covers up to two smoking cessation counseling attempts each year for tobacco users. Each attempt can include up to four face-to-face sessions with a healthcare provider, totaling eight sessions per year. These counseling services must be furnished by a qualified physician or other Medicare-recognized practitioner.
Medicare Coverage for Nicotine Replacement Therapies
When considering nicotine replacement therapies (NRTs) like patches, gums, or lozenges, Medicare’s coverage depends on the product’s classification. Over-the-counter NRTs, such as nicotine patches, gum, and lozenges, are generally not covered by Medicare Part D. This is because Part D legally excludes over-the-counter drugs.
However, Medicare Part D plans may cover certain prescription medications for smoking cessation. This includes prescription NRTs like nicotine nasal sprays and inhalers. Additionally, other prescription drugs, such as bupropion and varenicline, which aid in reducing withdrawal symptoms and cravings, are typically covered if they are on a plan’s formulary. The specific NRTs and other cessation medications covered vary between individual Part D plans, as each plan maintains its own formulary.
Understanding Costs for Covered Smoking Cessation
The out-of-pocket costs for Medicare beneficiaries seeking smoking cessation assistance vary based on the type of service received. For smoking cessation counseling covered under Medicare Part B, beneficiaries generally pay nothing. If the counseling is provided by a physician or other healthcare provider who accepts Medicare assignment, the service is covered at 100% of the Medicare-approved amount, meaning no deductible or coinsurance is applied. However, if a healthcare provider addresses a separate diagnostic issue during a preventive visit, Medicare may bill for that additional care.
For covered prescription smoking cessation medications under Medicare Part D, costs depend on the specific plan chosen. Part D plans typically involve monthly premiums. Many plans also have an annual deductible that must be met before coverage begins. After the deductible is satisfied, beneficiaries usually pay a copayment or coinsurance for their prescriptions. These amounts depend on the plan’s structure and the drug’s tier on the formulary.
Medicare Advantage plans, which are an alternative to Original Medicare, must cover at least the same benefits as Original Medicare, including smoking cessation services. Some Medicare Advantage plans may offer additional benefits, such as allowances for over-the-counter NRTs. As of 2025, the out-of-pocket spending cap for covered Part D drugs is $2,000.