Medicare beneficiaries who smoke and have smoking-related diseases or take certain medicines will be eligible for Medicare-covered counseling when the proposal takes effect next year. Medicare chief Mark McClellan said coverage would begin no later than the end of March.

Medicare would pay for up to four counseling sessions. If that doesn't suffice, smokers could get a second round of counseling.

The decision has broad support among health care providers and patient advocates, although some groups pushed for more extensive coverage, including for nicotine-replacement programs and some prescription drugs.

Medicare -- the government health program for 42 million older and disabled Americans -- will cover prescription medicines beginning in 2006.

"Quitting is hard, but counseling is a proven means of helping smokers succeed. It's cost effective and can double the chances of success," said John R. Seffrin, chief executive officer of the American Cancer Society.

Smoking is the top cause of preventable deaths in the United States, taking 440,000 lives a year, according to government estimates. Roughly 300,000 of those deaths occur among people 65 and older.

Tobacco use costs Medicare $14 billion a year.

Over 10 years, about 187,000 people would quit because of the counseling, according to the Campaign for Tobacco-Free Kids.

The program would cost Medicare just over $10 million a year, but savings in reduced health care costs would be greater than the cost over 10 years, the anti-smoking group said.

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