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Although the number of smokers in the U.S. has declined over the last 50 years, smoking still runs almost $170 billion in health-care costs each year, according to the National Institutes of Health. If you’re a nonsmoker, you might think you’re eligible for discounts on health insurance, including Medicare premiums.
In fact, the Affordable Care Act (ACA) recognized the financial burden smoking places on the health-care system. The health-care law allows insurance companies to charge smokers up to 50% more for health insurance premiums. The ACA smoking surcharge doesn’t apply to Medicare premiums, however.
If you’re a nonsmoker or former smoker and you’re wondering how it might affect your health-care costs, like Medicare premiums, here’s what the law has to say about nonsmoker discounts.
Once you’re enrolled in Medicare, you are guaranteed coverage under Part A and Part B regardless of your health status. Your Medicare premium isn’t higher if you’re a smoker than if you’re a nonsmoker.
Under existing Medicare law, everyone pays the same basic Medicare premiums for Part A and Part B, although some with higher income may pay a high-income surcharge in addition to the basic premium. Others may qualify for additional help with their Medicare premiums due to financial hardship.
The only adjustments to Medicare premiums allowed under law are based on financial status, not health status, so there are no discounts for people with good health habits such as not smoking, or higher Medicare premiums for people in poor health.
Medicare Advantage, also called Medicare Part C, operates under the same guidelines as Original Medicare (Part A and Part B). Medicare Advantage plans are simply an alternate way to get your Medicare benefits. They’re offered by private health insurance companies that contract with Medicare.
That means Medicare Advantage plans must accept anyone who qualifies, as long as he or she:
In general, if you meet these qualifications, you can’t be turned down from membership in a Medicare Advantage plan and you can’t be charged higher or lower Medicare premiums than anyone else enrolled in the plan.
Keep in mind, however, if you enroll in Medicare Advantage, you must continue to pay your regular Part B premium in addition to any premium due to your plan.
Medicare Supplement (Medigap) Insurance Plans are standardized private insurance policies designed to help cover your out-of-pocket costs under Original Medicare (Part A and Part B).
If you buy a plan during your Medicare Supplement Open Enrollment Period, you generally have guaranteed-issue rights, which means that you can buy any plan sold in your state. In most states, you can’t be charged more for your plan even if you have a pre-existing condition, or you smoke, or have serious health problems. There might be other situations where you might have guaranteed-issue rights.
Some states, however, do allow insurers selling Medicare Supplement insurance plans the right to adjust premiums for things such as gender and smoking status, even for those with guaranteed-issue rights. If you live in one of these states and you’re a nonsmoker, you may pay lower Medicare premiums for a Medicare Supplement insurance plan than someone who smokes.
If you don’t have guaranteed-issue rights, the situation is a bit different. Without guaranteed-issue rights, an insurance company may make you undergo medical underwriting before selling you a plan. During the medical underwriting process, the insurer might look at your age, health history, and lifestyle factors such as smoking and alcohol use. Depending on your situation, you might be turned down for coverage entirely, or charged a higher premium for the same policy than someone with guaranteed-issue rights. If you are a nonsmoker, you may be offered a lower premium than someone who smokes.
Generally speaking, however, smoking status does not affect Medicare premiums for most types of coverage. Medicare premiums for Part A, Part B, Part C, and Part D cannot be adjusted based on whether or not you smoke.
Please note: Medicare Supplement insurance plans don’t pay for your out-of-pocket costs with a Medicare Advantage plan, and they don’t cover costs associated with stand-alone Medicare Part D Prescription Drug Plans.
The product and service descriptions, if any, provided on these eHealth web pages are not intended to constitute offers to sell or solicitations in connection with any product or service. All products are not available in all areas and are subject to applicable laws, rules, and regulations.
eHealth's Medicare website is operated by eHealthInsurance Services, Inc., a licensed health insurance agency doing business as eHealth. The purpose of this site is the solicitation of insurance. Contact may be made by an insurance agent/producer or insurance company. eHealth and Medicare supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. We offer plans from a number of insurance companies.