Tobacco surcharges on 2015 health insurance plans sold in federally facilitated marketplaces: Variations by age and geography and implications for health equity

In 2014, few health insurance plans sold in the AffordableCareAct'sFederally Facilitated Marketplaces had age-dependent tobacco surcharges, possibly because of a system glitch. The 2015 tobacco surcharges show wide variation, with more plansimplementingtobacco surcharges that increase with age. This underscores concerns that older tobacco users will find postsubsidy health insurance premiums difficult to afford. Future monitoring of enrollment will determine whether tobacco surcharges cause adverse selection by dissuading tobacco users, particularly older users, from buying health insurance.