Short answer: Where allowed, insurers can charge tobacco users up to 50% more (a 1.5:1 ratio). Many states prohibit it, and where it’s permitted, a cessation program lets members avoid the surcharge.
Tobacco is one of the four factors the ACA lets insurers use to set premiums, with a maximum 1.5:1 surcharge. In practice its impact varies: several states ban it entirely, others allow the full surcharge, and the plan must offer a cessation program that removes it. For an employer, the surcharge (where it applies) raises the affected employee’s premium but not the rest of the group’s.
Sources
CMS, Market Rating Reformscms.gov/marketplace/private-health-insurance/market-rating-reformsKFF, tobacco surcharges in the Marketplace and state limitskff.org/faqs/faqs-health-insurance-marketplace-and-the-aca/marketplace-health-plans-and-premiums/can-i-be-charged-higher-premiums-in-the-marketplace-if-i-smoke