Tennessee ranks number four in the nation for the number of people vaping, or using e-cigarettes.

  • Oklahoma, Kentucky, and Indiana rank as the top three among states with highest rate of vapers.
  • 3.6 million middle school and high school students reported e-cigarette use.
  • Vapers could face 50% increase in health insurance rates if e-cigarette users are classified as tobacco users.

E-cigarettes work by heating up a liquid to create a vapor — the user breathes the vapor.

While the FDA does classify the e-cigarette as a tobacco product, it still tends to be a gray area for most insurance companies. Since e-cigarettes’ recent introduction into the marketplace, there’s been much debate over the health effects. Are e-cigarettes a nicotine alternative and cessation product to help smokers quit, or do they pose the same health risks as traditional cigarettes? As insurance companies learn more from e-cigarette research, health insurance premiums will be significantly impacted, for the better or worse.

If health insurance companies begin to classify e-cigarettes as tobacco use under the ACA, the Tobacco Use Surcharge could kick in. The Tobacco Use Surcharge is a rule under the ACA that allows insurers to increase premiums up to a maximum of 50 percent for enrollees who signal they use tobacco. All but a handful of states stick to the maximum 50 percent surcharge for tobacco users. The states listed in the top portion of our rankings are states that abide by the 50 percent surcharge. If e-cigarettes gain the classification as a tobacco product in the eyes of states and insurers, those folks could see a 50 percent increase in health insurance premiums


QuoteWizard analyzed 2017 data from the CDC’s Behavioral Risk Factor Surveillance System of e-cigarette users in all 50 states. Analysts took the crude prevalence of current e-cigarette users in each state and ranked all 50 states from the highest crude prevalence to the lowest crude prevalence. States with the highest crude prevalence are considered to have the highest rate of e-cigarette users and are therefore most likely to be affected by e-cigarettes in terms of their health insurance premiums. is a Web platform that enables users to compare insurance products and prices.



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