Smokers and the Marketplace: You Pay More, But Help Is Free

Tobacco (   Nicotiana tabacum   ). Photo by Derek Ramsey, 2006. Used under a Creative Commons license.

Tobacco (Nicotiana tabacum). Photo by Derek Ramsey, 2006. Used under a Creative Commons license.

If you are applying on the Marketplace ( to get subsidized health coverage, one of the last questions in the application is whether anyone in your household smokes at least four times a week. If the answer is yes? You might be in for some sticker shock.

Here's why.

Back in the old days, insurance companies could ask you about whether you had asthma, or high cholesterol, or were overweight, or whether you had cancer ten years ago. Now? They can't. And they can't deny you for any health conditions either (one exception is short-term plans that occur outside of open enrollment).

Now, on the Marketplace, insurers are setting your insurance rates based on how old you are and where you live, and not on whether you have congestive heart failure or diabetes. But they are also allowed to tack on a surcharge if you smoke. That surcharge might be somewhere between $50 and $100/month per smoker in the household, and the Advanced Premium Tax Credits--or subsidies--are set assuming that you are a non-smoker.

Which means...if you are a smoker, you will pay more.


The best way to think about why this is so, is that smoking serves as a proxy for some other risk factors. If you smoke, you are more likely to have problems with asthma, bronchitis, heart conditions or cancer. Since insurers can't ask about those things, they use "smoker status" as a way to assess how many more health services you might use.

Assuming you are telling the truth (and when you apply, you do sign something saying that you are telling the truth), the only way to get the costs reduced is to become a non-smoker. 


That's where the good news comes in. 

For plans on the Marketplace, smoking cessation assistance is free, even on a bronze plan.

That assistance might include the nicotine patch or gum; medications like Bupropion (Wellbutrin/Zyban) or Varenicline (Chantix); and even smoking cessation counseling. 

Stop smoking, and not only do you get help, and not only do you save money by not buying cigarettes or cigars or pipe tobacco, but also--down the road, you can save quite a bit more on health insurance.

Need more information? Contact us to get help getting covered.

--Ruth Kraut

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