The health benefits from quitting smoking have been well documented; however, most health insurance plans in the United States, both public and private, have excluded coverage of smoking cessation services. Since 1988, numerous public health policy documents have called for health insurance coverage of smoking cessation services, although there is little agreement over what kinds of services or interventions are most appropriate for health insurance coverage. The purposes of this paper are to (1) describe current public policy for health insurance coverage of smoking cessation services; (2) review the current status of policy adoption by private health insurance carriers, health maintenance organizations, self-funded employers, as well as public insurance programs including Medicare and Medicaid; (3) analyze the major barriers faced by health insurers, health care providers and policy makers in offering coverage for smoking cessation services; and (4) outline the specific policy options that the federal government, state governments, employers and anti-smoking coalitions can take to increase insurance coverage for smoking cessation services. The paper concludes with recommendations for practitioners, researchers and policy makers.