State insurance officials are investigating whether health insurers are covering tobacco-cessation products as a free benefit, as required under the Affordable Care Act.
“We have received several inquiries from [medical] providers and consumer groups,’’ said Glenn Allen, spokesman for the state insurance department, confirming the investigation.
There are questions about several Georgia insurers — operating through the ACA exchange, the regular insurance market or both — not covering the tobacco cessation products.
The health law requires that certain “preventive” benefits be covered without a co-pay, co-insurance or a deductible. Besides tobacco cessation, they include immunizations, as well as screenings for cholesterol, blood pressure, depression and HIV.
Allen said state Insurance Commissioner Ralph Hudgens’ office is working with the federal Centers for Medicare and Medicaid Services on the cessation product investigation.
Graham Thompson, executive director of the Georgia Association of Health Plans, declined to comment on the investigation.
Vicki Karnes, a nurse who co-chairs the Diabetes Community Action Coalition, said she helped press for an investigation after noticing that Georgia’s employee and teacher health plan covered the cessation products free of charge, while some other plans apparently did not. Tobacco use is a risk factor for developing Type 2 diabetes, Karnes said.
The co-pay preventive care rule extends to health plans that are self-funded by larger employers. (The exceptions are the benefits plans that are “grandfathered’’ into the current system. These plans must have been in existence prior to March 23, 2010, and cannot make significant changes to their coverage, such as increasing patient cost-sharing, cutting benefits, or reducing employer contributions.)
Karnes said the cessation products vary in price depending on strength, but could be $300 for a 90-day supply. Two attempts at treatment annually are covered.
Roughly one in five Georgia adults is a smoker.
The health dangers of tobacco are widely known, and many users want to quit. But the substance is as notoriously addictive as it is harmful. A 2010 CDC study found that 69 percent of adult smokers nationwide wanted to stop smoking, and 52 percent had tried to do so in the past year, but only 6 percent had actually managed to quit recently.
Cindy Zeldin of Georgians for a Healthy Future said it’s important for insurers to communicate with consumers about the free preventive services.
“No consumer enrolled in health insurance should face barriers accessing basic preventive services that can help them stay healthy, manage their conditions, and detect illness in its earliest stages,” she said. “We are concerned that some companies were not fully covering [tobacco cessation], but glad to learn that it is being investigated and look forward to the resolution.’’
This story was done in collaboration with Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. Andy Miller is the CEO and editor of Georgia Health News, a news organization covering health care in the state. The GHN website is georgiahealthnews.com.
About the Author
