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Medicare’s Alcohol-Dependency Counseling and Smoking Cessation Coverage

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Medicare health insurance isn’t just for doctors’ services and inpatient hospital care. Beneficiaries can get help for alcohol- and tobacco-dependency issues whether they’re enrolled in Original Medicare, Part A and Part B, or a Medicare Advantage plan. Original Medicare is the federally funded health insurance program, while Medicare Advantage plans are offered by private Medicare-approved insurance companies.

These counseling/educational services are covered under Medicare Part B. This insurance covers doctors’ services, some preventive care, and durable medical equipment. Beneficiaries who chose to receive their benefits through a Medicare Advantage plan, also called Medicare Part C, will find that they are covered as well because these plans must provide at least the same amount of coverage as Original Medicare, Part A and Part B (with the exception of hospice care, which is still covered by Part A).

Alcohol-dependency counseling

The U.S. Surgeon General defines alcohol dependency as “a maladaptive pattern of drinking, leading to clinically significant impairments or distress.” These are some of the symptoms:

  • Needing to drink more and more alcohol to reach intoxication.
  • Drinking to avoid feelings of alcohol withdrawal.
  • Drinking more or over longer periods of time than you used to.
  • Trying unsuccessfully to drink less.
  • Giving up social activities in favor of drinking.
  • Spending more time obtaining, drinking, or recovering from drinking alcohol.
  • Continuing to drink despite knowing how it harms you.

Medicare beneficiaries who consume alcohol, but don’t meet the medical definition of alcohol dependency as defined above, are eligible for an annual screening. The screening can help your primary care doctor decide whether or not you have a problem with alcohol. If your doctor finds that you qualify, you can get four counseling sessions each year with your primary care physician or other eligible provider. Counseling must be done in a professional setting, such as a doctor’s office or hospital.

The alcohol-dependency screening and counseling sessions are free and not subject to your deductible, as long as the physician accepts Medicare assignment.

Smoking and tobacco cessation

Smoking and tobacco cessation means quitting smoking. According to the Centers for Disease Control and Prevention, cigarette smoking is responsible for over 480,000 deaths each year, and causes more deaths than HIV/AIDS, illegal drug use, alcohol use, motor vehicle fatalities, and firearms combined.

Medicare Part B covers up to eight face-to-face counseling sessions each year. The counseling sessions are no cost, provided that the doctor accepts Medicare assignment.

The Part B deductible amount and coinsurance could apply if you’ve been diagnosed with an illness or complication caused by tobacco use, such as:

  • Cardiovascular disease
  • Respiratory disease
  • Cancer (all types)
  • Teeth and gum health
  • Type 2 diabetes
  • Rheumatoid arthritis
  • Impaired immunity
  • Cataracts

If you have Medicare Advantage, costs may vary, as Medicare Advantage plans are run by private insurance companies.

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