Quick answer
Yes, in most states. ACA plans can charge tobacco users up to 50% more than people who don’t use tobacco, and premium tax credits don’t cover that extra cost. Nine states and DC ban the surcharge, and a few others cap it lower. Job-based plans can also charge smokers more, but workers can generally avoid the charge by joining a quit-smoking program.
Key takeaways
- ACA plans in most states can charge tobacco users up to 50% more.
- Premium tax credits don’t cover the tobacco surcharge, so you pay all of it.
- California, DC, Maine, Massachusetts, New Jersey, New Mexico, New York, Rhode Island and Vermont ban the surcharge, and Virginia’s ban becomes permanent in 2027. Arkansas, Colorado and Kentucky cap it lower.
- For insurance, tobacco use means using tobacco four or more times a week on average within the past six months.
- ACA plans cover quit-smoking counseling and medication at no cost.
On this page
How the tobacco surcharge works
ACA plans can set premiums using only five factors: age, location, tobacco use, whether you’re covering just yourself or a family, and the plan category. They can’t use your health history. See how health insurance rates are determined.
Here’s an example. Say your plan’s premium is $600 a month and your tax credit is $400, so you’d pay $200. With a 50% tobacco surcharge, the insurer adds $300, and your tax credit doesn’t grow to cover it. You’d pay $500 a month.
| State rule | States |
|---|---|
| No tobacco surcharge | California, DC, Maine, Massachusetts, New Jersey, New Mexico, New York, Rhode Island, Vermont; Virginia (permanent from 2027) |
| Lower cap | Arkansas (20%), Colorado (15%), Kentucky (40%) |
| Up to 50% | Most other states |
Insurers can charge less than the maximum, so surcharges vary between companies in the same state. That’s worth comparing when you shop.
Job-based plans
Employers can charge tobacco users more, usually through a wellness program. If they do, they generally have to give you a way to avoid the charge, like finishing a quit-smoking program.
Why insurers charge more
Smoking is costly. According to the CDC, cigarette smoking kills more than 480,000 Americans a year and cost the country more than $600 billion in 2018, including more than $240 billion in health care spending. Health spending varies a lot by area too; see which cities spend the most on health care. When a smoker dies early, families can be left looking for new coverage; see health insurance options after a spouse dies.
Smoking-related conditions, like COPD or heart disease, are covered like any other pre-existing condition; see getting health insurance with pre-existing conditions. Other health factors, like your weight, can’t affect ACA premiums; for weight-related coverage, see will health insurance pay for weight-loss programs.
Quitting lowers your costs
ACA plans must cover tobacco screening and help to quit at no cost. That includes at least two quit attempts a year, each with four counseling sessions and a 90-day supply of FDA-approved quit-smoking medicines, prescription or over the counter, when your provider prescribes them. You can also call 1-800-QUIT-NOW for free help.
Tobacco status is based on when you last used tobacco. Once you’re no longer using it four or more times a week on average over the past six months, you can answer “no” on your next application. If you start smoking after you enroll, see what happens if I start smoking.
Finding affordable coverage if you smoke
Compare the surcharge along with premiums and deductibles, since it isn’t subsidized. See the cheapest ways to get health insurance and, if you’re asked for a test, nicotine tests and health insurance.
Compare plans in your area: see quotes by ZIP code.
Frequently asked questions
How much more do smokers pay for health insurance?
Up to 50% more on ACA plans in most states. Some states ban the surcharge or cap it lower.
Does vaping count as tobacco use?
The federal rule covers all tobacco products. Ask your insurer how it treats e-cigarettes and nicotine pouches.
What if I don’t tell my insurer I smoke?
The insurer can charge the surcharge back to the start of the plan year, though it can’t cancel your coverage for that reason.
When am I considered a nonsmoker?
When you haven’t used tobacco four or more times a week on average in the past six months.
Sources
- HealthCare.gov: How insurance companies set health premiums
- Healthinsurance.org: Are smokers unable to afford insurance under the ACA? (June 2026)
- KFF: Can a tobacco surcharge be covered by my premium tax credit?
- eCFR: 45 CFR 147.102, fair health insurance premiums
- CDC: Health and economic benefits of tobacco use interventions
- U.S. Department of Labor: ACA FAQs Part XIX (PDF)
This article is general information, not medical advice. Last reviewed September 2026.