Smoker or not, anyone applying for ACA-compliant health insurance (Obamacare) has to answer the question: Do you use tobacco? Does Smoking affect Health Insurance premium?

For those who smoke cigarettes, cigars, a pipe, or chew tobacco, the answer is simple. For those who ‘vape’ or use nicotine patches, gum, or pills, the answer is not so obvious. Smoking and Health Insurance is the most queried terms.

Let’s first consider why the question of smoking is so important and how smoking and health insurance link for a high premium.  Health insurance companies may charge higher premiums for applicants who represent a higher risk. Take, for example, life insurance.  You would expect to pay more if you had high-risk employment or regularly participated in dangerous sporting activities.   The Affordable Care Act treats tobacco usage as an ‘avoidable’ risk (unlike a pre-existing condition).

Many life-endangering illnesses and conditions such as COPD (chronic obstructive pulmonary disease), often associated with lung cancer, heart disease, stroke, and hypertension, are linked to tobacco.  These illnesses predictably raise the cost of treatment, and care and insurance companies may recognize this in their premium charging structure.

How much more will I need to pay if I am smoking and take health insurance.

An insurance company may raise premiums by up to 50% (restricted in many states), but most charge tobacco users 10-20% above the standard insurance premium.

Can I avoid paying higher premiums even if I smoke?

You can.  The health insurance industry is competitive. Look for an insurer who only minimally increases their premiums for tobacco usage.  Your best chance is to approach a QUALIFIED INDEPENDENT HEALTH INSURANCE BROKER, who has access to the insurers and plans which will best match your needs. (CTA).

NOW LET US CONSIDER THE QUESTION OF VAPING.  When the ACA was enacted (2010), tobacco risks were well-known, but “vaping” was just getting started.  To the layman, there was no distinction between the usage of tobacco and the habit-forming characteristic of absorbing nicotine. The term ENDS (Electronic Nicotine Delivery System), had not been created!

It is not the aim of this article to debate the merits and demerits of ‘vaping’ compared to tobacco usage.  Neither the ACA nor the health insurance industry distinguishes between the two.  

If you have used tobacco, whether cigarettes, cigars, chewing tobacco, e-cigarettes, or ‘vaped’ four or more times a week for the past six months, you are considered a tobacco user according to the health insurance industry. When you apply for health insurance, you must identify yourself as a tobacco user.

What are the risks if I don’t admit smoking?

Before ticking the ‘wrong box,’ it is essential to know the consequences.  If the insurer discovers that you or one of your dependents is a smoker, they can void your health insurance. They would undoubtedly raise your premiums and could sue you for previous underpayments.  Most of us benefit from a group (employer-sponsored) health insurance.   If you have knowingly made a false declaration on an employment group policy, it could also cost you your job.

At the very least, you will be subject to the Tobacco Surcharge. To discourage using tobacco products and to cover additional health care costs associated with tobacco use, many employers and insurance companies have Tobacco Surcharges. These are sometimes called tobacco premiums, premium incentives, or shown as nonsmoker discounts.

The Affordable Care Act (ACA) allows for tobacco surcharges, and because of the increased likelihood of medical complications for smokers, these surcharges can make health coverage nearly unaffordable.

I am planning to quit. When can I tick the “no” box?

If you ‘use tobacco,’ vape, or smoke ‘E’ cigarettes, four or more times a week and have done so for six months or more, insurance companies consider you to be a tobacco user.  Both health AND life insurance policies use this rule.  You can avoid higher premiums if you can legitimately state you have ceased ‘usage’ for the previous six months.

IF you can make this claim before December 15th (you already quit in June), you can tick the ‘NO’ box and add the premium savings to whatever you have saved already from not using tobacco.

Sadly, ceasing to ‘use tobacco’ does not qualify you for a SEP (Special Enrollment Period).  Fortunately, some other event, such as an addition to the family, a change of job, someone aging off your plan, or a change of location, may allow you to tick the other box!

I want to quit using tobacco. Where can I fin help?

If you are reading this, you already have the first requirement – the desire!  This article is not about self-help, but most people are trying to quit benefit from the advice and support of experienced councilors or support groups.

An excellent place to start is with your doctor, who will undoubtedly have the names and contact details of your local support groups.  Most states have a ‘Quitline,’ usually a free resource available 24/7.

The ACA Comprehensive Tobacco Cessation Benefits

All ACA compliant health insurance plans cover smoking (tobacco usage) cessation therapy, which is available at no charge.  Insurers must provide these services because of the significant health benefits for nonsmokers. 

The range of Tobacco/Vaping cessation treatments is complete:

  • Nicotine Patch
  • Nicotine Gum
  • Nicotine Lozenge
  • Nicotine Nasal Spray
  • Nicotine Inhaler
  • Bupropion
  • Varenicline
  • Individual Counseling
  • Group Counseling
  • Phone Counseling

And many websites and health forums advise, support, and provide encouragement. 

We suggest starting with If you reach out for a ‘smoke’ while reading this, try a banana instead!  Make that a habit!

For more formal information, try the American Lung Association or the Centre for Disease Control,


Photo by Irina Iriser from Pexels

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