Can I be charged higher premiums in the Marketplace if I smoke? Do e-cigarettes count?

In most states, yes. Generally, an insurer can charge you up to 50% more if you have used tobacco products four or more times per week on average during the past 6 months. This is called a tobacco surcharge. For example, if the premium for somebody your age (before any tax credits are applied) would otherwise be $200 per month, if you are a tobacco user, your premium could be increased to $300 per month. The rules about charging e-cigarette users a tobacco surcharge are less clear, but some insurers might.

If you qualify for premium tax credits, note that the tax credits will not cover any portion of a tobacco surcharge and will be based on the premium before the tobacco surcharge is applied. For example, if you choose a plan with a $200 monthly premium and you qualify for a premium tax credit of $75 but have a 50% tobacco use surcharge that adds $100 to the base premium, your $75 tax credit will be applied to the regular $200 premium. You would have to pay $225 for that policy: $200 for the regular premium, minus $75 for your premium tax credit, plus $100 for the tobacco surcharge.

Some states prohibit insurers from applying a tobacco surcharge or require lower tobacco surcharge rates. Additionally, some insurers opt to charge less than they are legally allowed to. Contact your state Marketplace or state insurance department to learn more.