Medicaid Coverage

The Wisconsin Medicaid program covers:

  • yesNicotine Gum
  • yesNicotine Patch
  • yesNicotine Nasal Spray
  • yesNicotine Lozenge
  • yesNicotine Inhaler
  • yesVarenicline (Chantix)
  • yesBupropion (Zyban)
  • yesGroup Counseling
  • yesIndividual Counseling
  • noQuitline

MCOs follow FFS benefits. All seven pharmacotherapy treatments are covered. Individual counseling is covered. Copays range from $0.50-$3. There is a limit of 10 individual counseling sessions per year.

For more information, please call the Wisconsin Medicaid Office Member Services at 800-362-3002, or visit their website at https://www.dhs.wisconsin.gov/medicaid/index.htm

Note: the Affordable Care Act requires all Medicaid programs cover all tobacco cessation medications beginning January 1, 2014. If a medication is marked here as not being covered, there is not yet evidence that Medicaid has complied with this requirement. Patients should call their Medicaid program and ask how to receive these medications.

Health Insurance Marketplace Coverage

All plans in the Health Insurance Marketplace are required to cover tobacco cessation treatment. Specific coverage varies by plan. Check with your insurance plan to find out what is covered.

State Employee Health Plan Coverage

Group Health Insurance covers:

  • yesNicotine Gum
  • yesNicotine Patch
  • yesNicotine Nasal Spray
  • yesNicotine Lozenge
  • yesNicotine Inhaler
  • yesVarenicline (Chantix)
  • yesBupropion (Zyban)
  • noGroup Counseling
  • yesIndividual Counseling
  • yesPhone Counseling

All seven pharmacotherapy treatments are covered. Individual and phone counseling are covered. There is a limit of 180 days of medication per year and four phone counseling sessions per year. There is a limit of one individual counseling session a year, although more sessions may be authorized by the health plan.

For more information, please call the Wisconsin Department of Employee Trust Funds at 608-266-3285 or 877-533-5020, or visit their website at http://etf.wi.gov/.

Private Insurance Coverage

This state does not require private health insurance plans to cover cessation treatments. Cessation coverage in private health insurance plans varies by employer and/or plan. Smokers with this type of health insurance should contact their insurance plan for information on cessation benefits.

This state does not mandate cessation coverage for private insurance plans.

Quitline

Contact Information: 1-800-QUIT-NOW; http://www.wiquitline.org/

Hours: 24 hours, Monday-Sunday

Eligibility to recieve counseling: 13 years and older. For medication: 18 years and older, without medical exclusions.

Medications provided:

  • yesNicotine Gum
  • yesNicotine Patch
  • noNicotine Nasal Spray
  • yesNicotine Lozenge
  • noNicotine Inhaler
  • noVarenicline (Chantix)
  • noBupropion (Zyban)

(Source: North American Quitline Consortium, www.naquitline.org)

American Lung Association Resources

The American Lung Association's Freedom from Smoking® program is available in select locations throughout the state of Wisconsin. N-O-T (Not On Tobacco) is currently being offered in schools and community organizations throughout the state and is widely available. Additional options include Freedom From Smoking® Online, a program available 24/7 at http://www.ffsonline.org and the American Lung Association's Lung HelpLine (800-LUNG-USA). For further information call 262.703.4200 or visit our website for a list of upcoming trainings and events at http://www.lungwi.org.