How Tobacco Use Affects Health Insurance

How Tobacco Use Affects Health Insurance text overlaying image of a cigarette Insurance companies can’t change your premiums based on your medical history or turn you down for any pre-existing conditions. However, they can change your premiums based on other things, such as whether or not you smoke. If you regularly smoke, vape, or even chew tobacco, your health insurance can cost up to 50% more. Companies use this “tobacco surcharge” to try to keep policyholders from smoking, since chronic conditions like COPD that are caused by smoking lead to high medical costs. However, even if you’re a smoker you can still find great health insurance. 

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What Counts As Tobacco Use?

All tobacco products, like vape juice, cigarettes, cigars, chewing tobacco, snuff, e-cigarettes, and pipes, are charged a tobacco fee by insurance companies. If you used any of these items four times a week or more in the last six months, that is considered tobacco use. Only people who use tobacco for religious or spiritual reasons, like Native Americans, are exempt from this surcharge. At the moment, insurance companies depend on people to tell the truth. When you ask for health insurance, you have to tell the company if you smoke or not. “Have you used tobacco in the last six months?” is a question that insurance companies often ask.


If you lie about how much you smoke, it could be called insurance fraud. Depending on where you live, giving a false answer to this question could be a felony that could cost you thousands of dollars in fines, jail time, and court fees, as well as a felony charge. If you get health insurance through your job, a regular medical exam could be used to check that your answers are true. During this test, a blood or urine sample can be used to check for nicotine use.

The Cost of Tobacco Use

Under the Affordable Care Act (ACA), health insurance rates are based on the type of plan, the number of people covered by it, their age, where they live, and whether or not they smoke. Many insurance companies can use the fact that a person smokes to raise their health insurance rates. This is called a “tobacco rating”. Subsidies are also affected. The full cost of the tobacco fee falls on people who smoke. The insurance company changes the premium based on age and location, but tobacco use is taken into account before that.


The tax credit isn’t used to pay for any of the tobacco fees. Through a “tobacco surcharge,” the Affordable Care Act (ACA) lets insurance companies charge users up to 50% more (or 1.5 times more) than they charge non-smokers. Even though this is legal, not all states have chosen to adopt this charge.  Surcharges on tobacco can be different in each state.

States that charge 50%

The States that charge less than 50%

States That Prohibit Tobacco Ratings Entirely

How Tobacco Affects Your Health

Smoking causes illness and disability, and it hurts almost all of your body’s organs. The Centers for Disease Control and Prevention (CDC) says that more than 16 million Americans have a disease caused by smoking. At least 30 people live with a serious disease caused by smoking for every person who dies because of it. About 41,000 nonsmoking adults and 400 babies die each year because they were around people who were smoking. Adults who are around people who smoke can get a stroke, lung cancer, and arterial heart disease. Children who are exposed to secondhand smoke are more likely to have Sudden Infant Death Syndrome, acute respiratory infections, middle ear disease, more serious asthma, respiratory symptoms, and slower lung growth. Smoking leads to:


When you smoke, you can get cancer and then your body can’t fight it. Toxins in cigarette smoke can damage the body’s immune system, making it harder to kill cancer cells. When this happens, the growth of cancer cells can’t be stopped. Tobacco smoke contains poisons that can damage or change the DNA of a cell. DNA is the “instruction manual” of a cell. It controls how a cell grows and works. When DNA is broken, a cell can start to grow out of control, which can lead to cancer. Cancer can form almost anywhere in your body if you smoke, including:


  • Blood (acute myeloid leukemia)
  • Bladder
  • Cervix
  • Colon and rectum
  • Esophagus
  • Kidney and renal pelvis
  • Larynx
  • Liver
  • Lungs, trachea, and bronchus
  • Mouth and throat
  • Pancreas
  • Stomach


Chronic obstructive pulmonary disease, or COPD, is a group of illnesses that block airflow and make it hard to breathe. Emphysema and chronic asthma are both parts of COPD. COPD is usually caused by smoking, but long-term exposure to other lung toxins, like secondhand smoke, can also lead to COPD. One out of every four Americans with COPD has never smoked. However,up to 8 out of 10 COPD-related deaths are caused by smoking, and 38% of the nearly 16 million U.S. people with COPD who are still smoking. When a child or teen smokes or is exposed to secondhand smoke, it can slow the growth and development of the lungs. This can make it more likely that they will develop COPD as an adult.


Diabetes is a long-term illness that changes the way your body turns food into energy. Most of the food a person eats is turned into glucose, a type of sugar that gives energy to the body’s cells. The pancreas is an organ near the gut that makes insulin. This hormone helps glucose get into the cells of the body. When you have diabetes, your body either doesn’t make enough insulin or can’t use it very well. Too much sugar stays in your system when there isn’t enough insulin or when your cells stop responding to insulin. Over time, this can lead to major health problems like heart disease, vision loss, and kidney disease. 


We now know that one thing that can lead to type 2 diabetes is smoking. In fact, people who smoke cigarettes are 30%–40% more likely to get type 2 diabetes than people who don’t smoke. People with diabetes who smoke are more likely to have trouble taking insulin and taking care of their health than people with diabetes who don’t smoke. If you smoke a lot, you are more likely to get type 2 diabetes.

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Gum Disease

Gum disease, also called periodontal disease, is an infection of the gums that can affect the bones that hold your teeth in place. In the worst cases, it can make you lose your teeth. Bacteria (germs) on your teeth get under your gums and cause gum disease. If the germs stay on your teeth for too long, they build up into layers of plaque and tartar. This buildup can lead to gingivitis, which is an early form of gum disease. When gum disease gets worse, your gums can pull away from your teeth and leave places that can get infected.


The bone and muscle that hold your teeth in place can break down, and your teeth may become loose and need to be pulled out. In the United States, smoking is a major cause of gum disease. Your immune system, which fights off sickness, gets weaker when you smoke. This makes it harder to get rid of an infection in the gums. If your gums are already damaged, smoking makes it harder for them to get better.

Heart Disease and Stroke

Cardiovascular illnesses (CVDs) include heart disease and stroke. In the U.S., coronary heart disease, also called coronary artery disease, is the most common type. Coronary heart disease happens when plaque builds up on the walls of the arteries that bring blood to the heart. A stroke happens when the brain doesn’t get enough blood or when a blood vessel in the brain breaks, damaging or killing parts of the brain. A stroke can cause death or injury, such as paralysis, weakened muscles, trouble speaking, or loss of memory. One out of every four deaths from cardiovascular disease (CVD) is caused by smoking.

How To Quit

Now is a great time to talk to your doctor if you smoke or use any other kind of tobacco. Under the Affordable Care Act, your health insurance plan can help you stop smoking by giving you the tools you need. One of the best things you can do for your health is to stop smoking or using any kind of tobacco. The faster your body can start to heal, the sooner you should stop. This is what happens after you’ve quit smoking:


  • 20 minutes – blood pressure and heart rate lowers
  • 12 hours – the amount of carbon monoxide in your bloodstream reduces
  • 3 months – your lung functions and circulation improve
  • 9 months – coughing and shortness of breath are less common
  • 1 year – your risk for a heart attack drops
  • 5 years – your risk of throat, mouth, bladder, and esophagus cancer severely drops
  • 10 years – lung cancer risk drops
  • 15 years – coronary heart disease risk reduces

Coverage for Quitting

Quitting doesn’t just improve your health it also improves your finances. Pack-a-day smokers can save between $1,380 and $2,540 annually, depending on where you live and the brand you smoke. Most health care plans, including all plans bought through the Marketplace, cover a screening for tobacco use. During this screening, your doctor will ask if you smoke or use tobacco and give you information about how it affects your health and why you might want to stop. Your health insurance may now cover free services that can help you stop smoking. This could include, depending on your plan:


  • Cessation counseling
  • Medication to help you quit
  • Nicotine replacements such as gum, lozenges, patches, inhalers, and nasal sprays

Keep in mind that grandfathered health plans, which are those that were in place before the Affordable Care Act was passed and haven’t changed much, are not required to give preventive care like help to quit smoking. Find out if you’re in a grandfathered plan by asking your insurance company or HR department. Also, short-term health plans don’t have to cover any preventative care including smoking cessation. 

EZ Can Help

No matter if you use tobacco products now, just quit, or are on your way to stopping, it is important to have health insurance. Many health problems can be caused by tobacco products, so it’s better to have insurance than to not have it and risk having medical bills pile up. If you smoke and want health insurance, but are worried about how much it will cost, EZ.Insure can help. We’ll look at the prices, compare plans in your area in minutes, and find you a plan that will save you money. Enter your zip code in the bar below to compare free quotes right away, or call 877-670-3557 to talk to a qualified agent.

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