OBJECTIVES: As part of the Affordable Care Act of 2010 (ACA), smoking cessation medications (SCMs) including bupropion, varenicline, and nicotine-replacement drugs, will be provided at no cost to people with health insurance. However, the scope of the potential impact of this policy was unclear. This study explored which populations would benefit from this mandate. METHODS: A retrospective cross-sectional study using the nationally representative Medical Expenditure Panel Survey 2009 was conducted. Adults who currently smoke, advised by doctors to quit smoking, or diagnosed tobacco-use disorders were extracted for analysis (weighted N=40,095,913). Chi-square tests and one-way ANOVAs were conducted to examine the heterogeneity in SCM use and related out-of-pocket expenses with respect to socio-demographic factors. A logistic regression was performed to examine the associations between socio-demographic factors and SCM use. All analyses were weighted based on complex survey design. RESULTS: Of the 40,095,913 smokers, only 3.1% of them used SCMs in 2009, whereas 52.1% were advised by doctors to quit smoking. Chi-square analyses revealed significant differences in SCM use based on race/ethnicity, relationship status, health insurance status, HMO status, perceived mental health status, and comorbid depressive/bipolar disorders (all p<0.001). Uses in buprorion and varenicline also varied with health insurance status (both p<0.05). There were significant differences in out-of-pocket expense for SCMs between smokers with different insurance status, with the uninsured paying the highest out-of-pocket price (p<0.001). The logistic regression revealed that non-Hispanic blacks were less likely to take SCMs compared with Hispanics (OR=0.30, p<0.01). CONCLUSIONS: Cost is a substantial barrier to SCM use among smokers. Once this barrier is lifted with the ACA, many smokers who do not currently use SCMs are likely to use SCMs unless they have unfavorable attitudes towards SCM use and smokers who currently use SCMs might switch to more effective but expensive SCMs.