Can the exchange charge me more if I smoke?
In most states, yes, you can be charged higher premiums on your exchange plan if you use tobacco products. Insurers are typically allowed to increase premiums as much as 50% for someone who uses tobacco, though not all choose to ask that much. Some states have also prohibited insurers from applying a tobacco surcharge or have reduced the allowed size of the premium increase, though the 50% rule is still the case in many areas. Check with your state’s exchange to learn more about the size of tobacco surcharges in your area and how they work.
“Tobacco use” is typically defined as having used some form of tobacco product an average of four or more times per week for the past six months, though states can reduce the six-month look-back period or increase the requirement for average weekly use. Again, check with the exchange in your state to see what rules apply where you live.
Changes in your smoking habits during the year will typically not impact the size of your premiums until you renew or change your plan at the end of the year. For example, if you take up smoking after purchasing your plan, your premiums will not increase during the year, but costs will go up when you renew for the following year. Similarly, if you quit smoking during the year, the insurer is not required to lower your rates until you renew.
If you qualify for a premium subsidy (premium tax credit), the size of the subsidy you receive will be based on the size of your premiums before the tobacco surcharge is applied. This means that tobacco users will have to pay the full cost of the surcharge themselves – it will not be covered by subsidies.
It is inadvisable to lie about tobacco use on your insurance application. If you do, the insurer is allowed to impose retroactive charges for it. However, they cannot cancel your coverage entirely.
How does the number of children included in a family plan affect premiums?