Insurers vexed by signs that exchange customers lie about smoking

Health insurers are concerned about evidence that Affordable Care Act exchange customers may be lying about their smoking status to avoid paying a surcharge on their monthly premiums, according to an article from Kaiser Health News.

Under the health reform law, insurers are allowed to charge higher premiums for members who smoke. New figures show signs that some smokers may be using deceit to avoid paying the surcharge, since in many states, the percentage of people who admitted to smoking when buying coverage on the exchanges is significantly lower than the overall percentage of adults who smoke in that state. For example, the article says, in Idaho, 17 percent of adults in the state smoke but only 3 percent who bought coverage on the state exchange paid the tobacco surcharge.

Insurers are disappointed by these results, but they are not surprised, KHN says, given that they aren't allowed to independently check if consumers are actually smokers. The ACA allows insurers to impose retroactive surcharges if they find someone lying about tobacco use, but they cannot drop coverage for anyone who is caught lying.

"It means nonsmokers will pay more because smokers generally have higher healthcare costs that were supposed to be partly offset through the surcharge," Josh Jordan, a spokesman for Blue Cross of Idaho, tells KHN, adding, "a lack of people paying it means everyone else may pay more."

Many insurers are actually applying lower premium surcharges to consumers who smoke than what they are allowed to under the ACA, FierceHealthPayer previously reported. Still, the low rate of admission to tobacco use hampers insurers' ability to adequate premiums for everyone, Scott Streator, a senior vice president with ACA health plan CareSource, tells the publication.

To learn more:
- here is the article

Suggested Articles

While Republicans are blasting Nancy Pelosi's drug plan as socialist, hospitals and insurers are finding a lot to like.

MA plans want to offer supplemental benefits but warn that the additional flexibilities offered by the feds may not be enough to really target beneficiaries.…

Industry efforts to lift a ban on using federal funding for a unique patient identifier hit a roadblock in the Senate Wednesday.