How Do Health Insurance Companies Know if You Smoke?

smoking matches

The next time you sign up for health insurance, you’ll be asked whether or not you use tobacco. This is because your answer might change how much you’ll pay for coverage.

While health insurers can’t reject people who smoke, they can charge smokers higher monthly premiums than non-smokers. Click To Tweet

With the rise of electronic smoking products – Juul e-cigarettes have been spotted all over the country – the old rules for tobacco have gone up in smoke. We’re covering all of the definitions, legislation, and prices when it comes to health insurance and smoking.

How Do Health Insurance Companies Know If You Smoke?

If you fail to acknowledge your current tobacco use to health insurance companies, you’re misrepresenting the health risks you pose. Regular smokers may be tempted to avoid telling the truth in exchange for a lower premium price. However, your health insurance plan can further investigate your tobacco use.

Although it’s nearly unheard of for a company to actively investigate whether or not you smoke, your doctor will probably note tobacco use in your medical records. This could be uncovered by accident as an insurer is paying your bills.

There are a few ways for your health insurance company to test if you use tobacco. They may ask for a blood or urine sample to test for nicotine. If your health insurance company learns of your false tobacco use, they can rescind your benefits or take legal action. They can also require you to pay the company the additional amount charged to smokers. Being honest when you answer enrollment questions is in your best interest.

What Is a Tobacco Rating?

Health insurance premiums depend on 5 key factors:

  • How old you are,
  • Where you live,
  • Your plan category,
  • Number of dependents, and
  • Your tobacco use.

If you use tobacco, health insurance companies can charge you more to stay on a plan – up to 50 percent more to be exact. This is also known as tobacco rating.

Tobacco use is on a short list of factors that affects how much you pay for health insurance. Click To Tweet

When Does Tobacco Rating Apply? 

Casual smokers may be able to avoid tobacco surcharges. Tobacco use must rise to a certain level before it can be used by health insurance companies to penalize you.

According to the Department of Health and Human Services, insurance companies consider folks who use “tobacco use” to mean people who:

  • Use tobacco products – including cigarettes, cigars, pipe tobacco, and chewing tobacco,
  • On average of 4 or more times per week,
  • Within no longer than the past 6 months.

One exemption to this ruling is the religious or ceremonial uses of tobacco products, like tobacco use by American Indians and Alaska Natives.

Where Does Tobacco Rating Apply?

States have different policies when it comes to charging smokers more.

States without any tobacco rating (they won’t charge tobacco users more than non-users):

  • California
  • Connecticut (plans on state marketplace only)
  • Massachusetts
  • New Jersey
  • New York
  • Rhode Island
  • Vermont
  • Washington D.C.

States that use tobacco rating, but allow a maximum upcharge of less than 50 percent for smokers:

  • Arkansas – 20%
  • Colorado – 15%
  • Kentucky – 40%

In all other states, smokers can be charged 50 percent more for monthly premiums compared to non-smokers.

Costs for Smokers Versus Non-Smokers

Health insurance companies can charge smokers up to 50 percent more for premiums compared to non-tobacco users. This is a measure of caution for companies because smokers are more likely to face health problems. However, there are also insurance companies that are “smoker-friendly”. These insurers may not charge you as much because you use tobacco products.

Smoking and the Affordable Care Act

The Affordable Care Act (or Obamacare) has a few clauses to help individuals who use tobacco products. Major health insurance companies cannot deny coverage due to health status. This is encouraging to tobacco users who are looking to enroll in a health insurance plan.

While the premiums for smokers may be higher compared to non-smokers, your copayments and coinsurance won’t change.

If you are looking to quit tobacco use, cessation programs as preventive care fall under the essential health benefits that ACA health insurance companies are required to cover. You won’t have to pay any out-of-pocket costs for most smoking cessation programs, which can include counseling, prescription cessation medication, or replacement therapies.

Juuls, E-cigarettes, and Vaping

Today, many people are turning to electronic smoking devices, such as Juuls, e-cigarettes, and vapes. These products don’t use tobacco; however, they contain other harmful substances when inhaled, including nicotine.

Due to the recent popularity of electronic smoking devices, studies on the effects of these products have yet to be fully published. Therefore, it remains difficult for health insurances to determine whether or not to label this group of individuals as smokers.

Because of the lack of tobacco, e-cigarette users may be unsure whether to indicate if they are a smoker when signing up for health insurance. For complete transparency, you should contact your health insurance company to ask questions about smoking.

Once You Join A Plan As A Tobacco User

If you begin smoking after you’ve joined a health insurance plan, you may need to let your health insurance company know during the next time they renew your coverage (usually at the start of the year). By being truthful as you fill out your application, you can save time and money down the road.

The consequences for misrepresenting your tobacco use should convince you to be honest when signing up for health insurance. You can take advantage of free cessation programs once you have health insurance, if they so choose.

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