Can your doctor tell your insurance that you smoke?

Finding affordable health insurance is a struggle for many Americans. When you’re looking for a new healthcare plan, you want to feel confident that you’re acquiring the best rate and coverage possible to meet your specific needs.

This tricky process becomes even more nuanced if you’re a smoker.

For instance, being that you smoke, you may have experienced a higher cost of healthcare coverage with a past provider. Perhaps you’re wondering, should you be fully transparent with your doctor, if they can tell an insurance provider that you smoke cigarettes.

First things first: a doctor cannot legally tell an insurance company you smoke.

Still, that doesn’t mean your insurer won’t uncover that information, nor does it mean there won’t be any consequences if they do. Keep reading to learn more about the relationship between smoking and health insurance rates.

Whether you smoke or not, you can save on your health insurance costs by comparing different companies. Use our free search tool to find the best health insurance rates near you today.

HIPAA and Health Insurance

HIPAA (Health Insurance Portability and Accountability Act of 1996) protects the privacy of your private health information. This means that you have control over who can access your records.

Due to HIPAA, your doctor is not allowed to discuss whether or not you smoke with your provider. However, your doctor can send copies of your medical records for the following reasons:

• For payment of a bill
• For permission for treatment
• With your permission (typically with a signed form)

Your records will likely contain notes about your smoking or nicotine use habits (if these were discussed during a visitation).

How Can Your Health Insurer Find Out You Smoke?

Your medical records are the most common way your insurer will find out you smoke if you were dishonest on your insurance application paperwork. In rare cases, your insurance company may try to do some digging on their own but typically only if they have a reason to suspect there was previous wrongdoing.

What Happens if You Lie to Your Insurance Company About Smoking?

Lying about smoking on health insurance is considered insurance fraud. And yes, that’s a crime. Even if your premiums are higher due to your smoking habit, the consequences of lying are far more severe than paying more for coverage.

Some of the consequences include:

• You can be charged with insurance fraud
• You might lose your health insurance coverage
• If your insurance company doesn’t drop you, you may have to pay back the premium difference you would have paid as a smoker

In which case, the risks likely far outweigh the reward of being dishonest.

Can You Be Refused Health Care Coverage if You’re a Smoker?

No, you cannot.

The Affordable Care Act prohibits insurance companies from denying you health insurance coverage based on pre-existing conditions and smoking habits. However, it does allow insurance companies to charge you up to 50% more for your premium if you smoke.

Let’s delve into how much smoking can impact the price you’ll pay for health insurance.

Smoking and Health Insurance Premiums

As we’ve mentioned, smokers can expect to pay up to 50% more in healthcare premiums. To quantity an exact amount, you need to take the following factors into consideration: 

• Your location – 40 States allow insurance companies to charge the full 50% more in premiums for smokers. However, Arkansas, Colorado, and Kentucky set limits between 15 – 40%. Vermont, New Jersey, New York, Rhode Island, Connecticut, Massachusetts, and California don’t allow insurance companies to charge higher premiums for smokers.
• Your age – Age, as you could imagine, affects your health insurance premium. Older people, whether they’re smokers or non-smokers, pay more for their health insurance plan. This all boils down to liability and a person’s health risk profile.
• Your plan – Insurance companies typically have different levels of coverage. You’ll pay more for a plan with a lower deductible. If you’re a smoker, you’re more likely to need more healthcare as you age. You’ll probably want to consider a robust plan that can mitigate the financial consequences of adverse health events. This will cost more.
• Your family – If you and your spouse are covered under the same plan, and you’re both smokers, you might pay more than if just one of you is.
• Your tobacco rating or usage – Lastly, your tobacco rating, or the amount of tobacco you use, will influence the extra surcharge you pay for health care. The insurance industry has specific guidelines for what constitutes a smoker, and these are used to apply the allowable surcharge to your health insurance premium.

What Is Considered a Smoker?

The categorization of a “smoker” can be a bit of a grey area. The Department of Health and Human Services considers you a tobacco user if you smoked or used tobacco products at least four times per week over the past six months.

Now, it’s important to keep in mind that it’s not relegated to cigarettes. The guidelines for a tobacco rating also include:

• Pipe tobacco
• Cigars
• Chewing tobacco
• E-cigarettes and vaping

E-cigarettes and vaping devices, while not tobacco products, were labeled as such by the FDA in 2016. This allows insurance companies to charge the same higher premiums they would for cigarette smokers.

Previous Smoker

If you’ve successfully quit smoking, that’s fantastic. However, you’ll need to wait until you renew your premium the following year to reap the benefits of nonsmoker premiums. When renewal time comes around, you’ll need to redress your prompt and reflect the accurate information in your answers (that you, of course, no longer smoke).

Example of Cost Difference

Let’s say you’re a smoker. Today, you’re comparing quotes for health insurance plans. The best rate you receive is $295 per month. Your total cost — not including out-of-pocket expenses — for one year, is $3,540.

If you quit smoking and apply for the same plan the following year, you can expect to pay far less. Maybe you live in a state that charges a 25 percent tobacco surcharge. Your rate could fall to $221.25 per month or $2,655 per year.

That’s a savings of $885 just on the premium of your health insurance policy.

This doesn’t include the money you’ll save on cigarettes and long-term health problems (which might be a lot more than the difference in your premium).

Does Health Insurance Cover Resources for Quitting Smoking?

Yes, if you’re trying to quit smoking, your health insurance should cover the resources you need. As part of the Affordable Care Act, most private and public health care coverage providers are required to cover the smoking cessation medications approved by the FDA.

These medications include:

• Nicotine patches
• Nicotine gum
• Nicotine lozenges
• Nicotine inhaler
• Nicotine nasal spray
• Chantix
• Zyban

You’ll also have access to smoking cessation programs through your health insurance company. It’s in the best interest of health insurance companies for you to quit smoking. The healthier you are, the less you will cost your health insurance company in the long run.

Additional Costs Accrued If You’re a Smoker

Not only will you end up paying more in health insurance costs, but did you know smoking can increase the price of other insurance types, too? To that end, smokers pay significantly more for homeowners and life insurance.

• Life insurance – If you smoke, you can expect life insurance rates up to four times as high as non-smokers.
• Homeowners insurance  – You’ll also pay more for homeowners insurance as a smoker. This is because cigarettes are one of the top causes of house fires. The extra amount you’ll pay varies by insurer, but it’s typically around 20% more than a nonsmoker.
• Resale value – Smoking also affects the resale value of your home or car. Not only will you pay more to insure your assets, but you’ll also make less money in a sale (if there are smoke stains, a cigarette miasma, or visible damage). The same is true of your car. Smoke damage significantly reduces the resale value of your assets.

Case Studies: Can Your Doctor Tell Your Insurance That You Smoke?

Case Study 1: MedHealth Insurance Company

John D., a 40-year-old individual, had been a smoker for over two decades. Seeking better health and lower insurance premiums, he decided to quit smoking and underwent a successful smoking cessation program. However, when applying for a new insurance policy with MedHealth Insurance Company, John was surprised to find that his rates were significantly higher than expected.

After conducting further investigations, he discovered that his previous physician had disclosed his smoking history to the insurance company without his consent.

Case Study 2: WellLife Healthcare Insurance

Samantha R., a 35-year-old professional, had been a non-smoker for several years. During a routine check-up, her doctor mistakenly recorded her as a smoker in her medical records. Samantha, unaware of this error, later applied for a new insurance policy with WellLife Healthcare Insurance.

To her dismay, she received a notification that her premium rates were substantially higher due to her supposed smoking habit, which she vehemently denied.

Case Study 3: HealthyWay Insurance Corporation

Michael S., a 55-year-old individual, was an occasional cigar smoker. While this habit did not significantly impact his overall health, Michael was concerned about potential repercussions when applying for a life insurance policy. Prior to submitting his application to HealthyWay Insurance Corporation, he had an open conversation with his doctor about his smoking habits.

To his relief, his doctor assured him that unless smoking posed a significant health risk, it would not be disclosed to the insurance company. Michael’s application was subsequently approved at standard rates.

Case Study 4: VitaCare Health Insurance

Emily K., a 28-year-old woman, had recently quit smoking after five years of regular cigarette use. She decided to switch her health insurance provider from VitaCare Health Insurance to a different company that offered better coverage. When filling out her application, she truthfully answered “no” to the question about current smoking habits.

However, VitaCare contacted her new insurer and informed them of her past smoking history, resulting in an adjustment to her premium rates.

Find the Best Rates on Health Insurance

Our mission is to help you find the best rates and coverage for all your insurance needs. If you’re a smoker, depending on the circumstances, you might end up paying a higher premium. And even though your doctor can’t explicitly tell them you smoke, the insurance company can still uncover the information.

However, this doesn’t mean that you can’t find reasonable coverage. Smoker or not, that’s what we’re here for! Use our free tool today to search and compare coverage and rates across many different insurers and find one that perfectly complements your needs.

While it goes without saying, if you have an opportunity to quit cigarettes, we’re rooting for you. Both your wallet and body will thank you.