Do Insurance Companies Consider Vaping Smoking?
Are Vapers smokers? Should they be subjected to smokers’ rates for health insurance? Does nicotine count as tobacco use since it is derived from tobacco leaves? The answers are widely divided and depend on whom you ask. As more and more people switch to electronic cigarettes, some new questions are being asked. Does my health insurance rates increase if I vape?
Vapers consider e-cigarettes a vastly healthier alternative to cigarettes and often state that they have quit smoking. They say that using an e-cig for nicotine delivery is little different from using a nicotine patch or gum.
Those who advocate tobacco classification believe that e-cigarettes are dangerous, especially for young people, specifically because they do contain nicotine. Some believe that the devices act as a gateway to using traditional cigarettes.
Part of the problem is that there are no long-term health studies available, and although the U.S. Food and Drug Administration (FDA) announced its intention to regulate electronic cigarettes in the same manner as tobacco, they have not yet set anything as law. This leaves many insurers, who take their cues from the agency, up in the air.
One alternative to tobacco classification is to consider e-cigs an official method to aid smoking cessation, which would make them medical devices. There have been few scientific studies as yet, but most early evidence appears to support them at least as a healthier substitute for cigarettes.
The Affordable Care Act (ACA) allows only four criteria in determining insurance rates: age, family size, location and tobacco use. Use is defined as four or more times per week over six months, and smokers may have an up to 50-percent surcharge added to their premium costs. However, the law also states that insurance carriers must include smoking cessation plans, and any smokers who enroll are exempt from the surcharge.
The ACA doesn’t specifically include e-cigarettes under the tobacco surcharge. Neither does it list them as recognized Nicotine Replacement Therapy (NRT). Because the law is unclear; the FDA hasn’t yet done more than propose tobacco classification; and the Centers for Medicare and Medicaid Services are also undecided on this matter, insurance companies are left to decide for themselves. Until this is settled definitively, getting a carrier’s official policy in writing could help avoid claim denial if you want to declare nonsmoker status with e-cigs.
Meanwhile, the FDA has complicated things by removing restrictions on the length and manner of using NRT. Although it isn’t directly spelled out, someone could possibly use a nicotine patch or gum for years and still qualify for nonsmoker rates under the ACA. But what about e-cigs? Given the emerging scientific evidence, there could be many lawsuits if e-cigs are left out of NRT definitions.
Vaping and Insurance Carrier Positions
Another problem e-cig users face is nicotine tests. Although not actually using tobacco, tests will still read positive and lead to smoker status.
It can take up to two weeks for nicotine to leave your system. Tests on blood, urine or saliva measure the level of a nicotine byproduct called cotinine, which is present with all nicotine use. There is a further test for a byproduct called anabasine, which is present in tobacco but not NRT products; there’s no clear discussion on whether insurers might adopt the anabasine test.
Life insurance companies have taken a strong lead on this whole issue. Up to 90 percent of all underwriters consider e-cigarettes the same as tobacco. They also consider NRT to be tobacco use, and they require tests before insuring anyone. They say a person must be nicotine free for at least a year to qualify for nonsmoker rates; some require up to three years. Prudential is the only major carrier that doesn’t consider e-cig users to be smokers.
A few health insurance carriers currently don’t consider e-cigs as tobacco use. They include UPMC Health Plan, Anthem Blue Cross and Blue Shield of Missouri and Coventry Health Care, which is part of Aetna. Few companies are likely to join these insurers unless e-cigs are certified as “safe and effective” for therapeutic use.
Health Agency Positions
If the FDA listens to various health organizations, e-cigarettes will most certainly be classified as tobacco products. The World Health Organization, the American Heart Association, the American Public Health Association, the American Association for Cancer Research and the American Society of Clinical Oncology all want strict regulations equaling tobacco. Some even want to ban internet sales or at least require proof of age with both purchase and delivery. A minimal bright spot is that all these organizations appear to support further research into whether e-cigarettes are suitable for NRT. Still, studies are so new and so lengthy that Vapers will probably have to pay smokers’ rates for health insurance once the FDA does act.