A new study has found that many private insurance companies are not complying with the Affordable Care Act’s provisions requiring all new insurance plans to cover preventive services that include smoking cessation programs at no cost.
Georgetown University researchers studied 39 insurance contracts sold in six states including individual, small group, federal employee and state employee plans. Here are a few broad findings of the report that was commissioned by the Campaign for Tobacco-Free Kids and Pfizer.
- Twenty-six out of 36 contracts that state that they cover preventive services consistent with the U.S. Preventive Services Task Force actually partially or entirely exclude tobacco cessation programs.
- Only four of the 39 contracts explained that they covered smoking cessation individual, group and phone counseling as well as both over-the-counter and prescription medications to help smokers quit.
- Flouting the law, some insurers require cost sharing. Seven of the 36 contracts that covered the ACA-mandates counseling services require the covered individual to pay a certain amount to share treatment costs. The same was true for six of the 24 contracts that covered prescription medication.
“It is shocking to see the huge variation in what appears to be a straight-forward, inexpensive benefit that has significant medical evidence on treatment that works,” Mila Kofman, principal author of the report and former Maine superintendent of insurance said, in a news release. “It is even more disappointing to find that some in the insurance industry are trying to avoid covering tobacco cessation treatment as required by the Affordable Care Act.”
The insurers evaluated in the report belonged to six states: Florida, Kentucky, Nevada, New Jersey, Oregon and South Dakota. The report did not identify the insurers and Kofman confirmed that no names are being disclosed.
But the report did provide some recommendations to help regulators make sure that insurers are complying with federal law. Here are two:
- Regulators should mandate that insurance policies contain clear language that shows that tobacco cessation treatment is a covered benefit and include which treatments are covered. They should also confirm that cost sharing will not occur.
- Regulators should provide guidance on permissible and prohibited limitations to coverage under the ACA.
Read the full report here.
[Photo Credit - Lady smoking from Big Stock Photo]