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E-Cigarettes: The Good, the Bad, and the Health Insurance Costs

Health care advocates and experts can’t agree on the risks of e-cigarettes, leaving vapor smokers confused about health insurance premiums.

When Insurance Meets Smoking

Smoking is bad. That’s not exactly a controversial statement, but with the huge concern over the health care risks of smoking, we sometimes forget the financial risks smoking can incur – and those are pretty bad too. Cigarettes cost money, medical problems associated with tobacco use are expensive to treat, and as for insurance for smokers? Yup; that costs more money too – even if the cigarettes are vaporized, e-cigarettes. 

In the United States, health insurers have always charged smokers more – which makes sense. A smoker, especially one over the age of 40, is more likely to incur medical costs than a non-smoking policy-holder of the same age. Smoking cigarettes can lead to cancer, heart disease and stroke, not to mention regular struggles with respiratory health and the generally poorer health that comes with a weakened immune system. 

How Do Insurers Deal with Smokers?

When an insurer takes on a smoker, they are taking on a higher financial risk, and the recently-passed Affordable Care Act demonstrated lawmakers’ commitment to keeping insurance prices for smokers high. Although American insurers are now prohibited from charging more to policyholders with pre-existing conditions, insurance companies are allowed to set smokers’ premiums up to 50 percent higher. Some critics of the ACA have said that this penalty imposes an unfair financial burden on poor Americans in particular, while others argue that high insurance prices – along with the ACA’s free tobacco counseling and cessation services – could encourage tobacco users to quit.   

Residents of nations with a public health care system – including  the United Kingdom, France and Australia – won’t notice a difference in their health care costs, regardless of tobacco use. However, many people living under a socialized health care system choose to purchase additional private insurance – which will cost more for people who smoke. 

But nowadays, lots of people have stopped smoking cigarettes and turned instead to e-cigarettes: do these smokers still pay more for health insurance? 

E-cigarettes and Insurance

Insurance costs for e-cigarette smokers is an extremely topical discussion, and at the moment leading health authorities are attempting to assess the health risks of e-cigarettes. The Centers for Disease Control and Prevention in the United States has reported that from 2011 to 2012, use of e-cigarettes amongst middle and high school students increased by more than 100 percent. That statistic worries anti-tobacco advocates concerned that e-cigarettes could encourage more young people to start smoking – nicotine is highly addictive, and what starts as a seemingly harmless intake of nicotine vapor could turn into regular use of conventional cigarettes.   

At the same time, some think e-cigarettes represent a modern – and effective – method of helping smokers quit or even just saving their lives. This month, the British Journal of General Practice released an editorial by researchers from the University College London arguing that e-cigarettes are less harmful than conventional cigarettes and shouldn’t be regulated as tightly. The London research team noted that tar is the most harmful aspect of cigarettes, and by offering users a tar-free smoking experience, thousands of fatalities could be avoided every year: and what’s more, UCL researchers also found that smokers were 60 percent more likely to quit conventional cigarettes if e-cigarettes were on hand. 

E-cigarette users in the United States are still unsure how their vapor smoking can affect insurance premiums. The U.S. Food and Drug Agency has yet to determine if e-cigarettes are a “tobacco product,” so at the moment it seems that health insurance companies can’t charge e-cigarette smokers higher premiums. (The Affordable Care Act requires that insurers use just four determining factors to set premium prices: location, family size, age and tobacco use). Still, some insurance policies do identify e-cigarettes as a tobacco product, and meaning that e-cigarette users are subject to the same insurance rules as a smoker – for example, a new e-cigarette user may be required to identify her vapor cigarette use or risk rendering an insurance policy void. 

E-cigarette users should also be aware that most health insurance providers don’t cover e-cigarettes as a form of nicotine therapy. Aetna, an insurer offering a range of private international policies, informs customers that e-cigarettes are considered a smoking replacement rather than cessation therapy, and therefore won’t be paid for by the company. 

Many smokers have come forward with stories of how vapor cigarettes helped them quit conventional cigarettes, but at the moment, insurance companies aren’t identifying e-cigarettes as a legitimate health product – and with a recent report from the World Health Organization advocating stricter regulations on e-cigarettes, it’s unlikely that insurance companies will waver from this stance in the future. The WHO report, released in August, warns that e-cigarettes present a range of health care risks: including nicotine exposure to smokers and bystanders, and the potential e-cigarettes have to increase smoking amongst children and teens. The report recommends that countries limit underage access to vapor cigarettes, and restrict the use of e-cigarettes indoors.  


This report from the World Health Organization, along with other evidence from advocates of tobacco-free living, offer legitimacy to insurance companies wanting to keep premiums high for e-cigarette users. Unsure about your insurance provider’s e-cigarette policy? Call them up and ask. It’s always better to declare your nicotine use rather than risk a coverage void. If you’re hoping to rely on e-cigarettes as a form of tobacco cessation, best of luck: there’s plenty of evidence it works, but don’t expect insurance coverage just yet.

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