If I Tell My Doctor I Smoke, Will My Insurance Go Up?

It is a common concern among individuals whether sharing personal health information with a doctor, such as smoking status, could lead to increased insurance costs. This apprehension often stems from a lack of clarity regarding patient privacy, how different types of insurance operate, and the mechanisms insurers use to gather and utilize health data. Understanding the distinctions between doctor-patient confidentiality, health insurance regulations, and life insurance underwriting practices can clarify how such disclosures might affect premiums.

Doctor-Patient Confidentiality and Data Sharing

A patient’s medical information shared with their physician is protected by privacy regulations. The Health Insurance Portability and Accountability Act (HIPAA) sets national standards for the protection of sensitive patient health information. HIPAA prohibits healthcare providers from disclosing protected health information to third parties, including insurance companies, without explicit patient consent. Doctors cannot proactively inform an existing health insurer about a patient’s smoking status without patient authorization.

While doctors maintain confidentiality, a patient’s own disclosures on insurance applications are treated differently. When applying for new insurance, individuals are asked direct questions about their health, including tobacco use. Information provided by the applicant on these forms, not a direct report from their doctor, is the primary source insurers use to assess risk and determine eligibility or pricing.

Impact on Health Insurance Premiums

Health insurance premiums are largely shaped by the Affordable Care Act (ACA). Under the ACA, health insurers cannot deny coverage or charge higher premiums based on pre-existing health conditions, including a history of smoking. This applies to most individual and small group health insurance plans. An existing health insurance policy’s premium will not increase simply because a doctor notes a patient’s smoking status in their medical records.

However, the ACA does allow health insurers to apply a “tobacco use surcharge” to premiums for individual and small group plans. This surcharge can increase premiums by up to 50% for individuals who use tobacco. This cost applies if the individual indicates tobacco use on their insurance application or during a health assessment, not if their doctor reports it. The surcharge reflects the higher healthcare costs associated with tobacco use.

Impact on Life Insurance Premiums

Life insurance operates differently than health insurance in assessing risk and setting premiums. Life insurers engage in an underwriting process, where an applicant’s smoking status significantly determines their risk profile and policy cost. Individuals who smoke or have a recent history of smoking are classified as “smoker” or “tobacco user” rates, which are substantially higher than non-smoker rates.

During the life insurance application process, applicants are asked about their smoking history, and misrepresenting this information can lead to policy cancellation or denial of claims. Life insurers often require medical examinations, which may include tests for nicotine or its byproducts. They may also request access to an applicant’s medical records with consent. Any notation of smoking in these records, combined with applicant disclosures, directly influences the premium charged.

The Medical Information Bureau

The Medical Information Bureau (MIB) is a non-profit organization that helps insurance companies detect fraud and misrepresentation on applications. Member insurance companies report coded information about health conditions, hazardous avocations, and other risk factors, including tobacco use, identified during underwriting. This information is a summary of reported conditions, not a detailed medical record.

If an individual applies for a new insurance policy with a different MIB member company, that company can query the MIB database to ensure consistency with previous applications. The MIB does not receive information directly from doctors; its data comes from information submitted by insurance companies based on their underwriting findings. The MIB serves as a tool for insurers to verify applicant information. It does not directly impact existing insurance policies or involve direct reporting from healthcare providers.