Life Insurance
The Most Expensive States for Smokers Mix Aging Populations, Low Incomes and Poor Access to Quality Care
The financial effects of smoking cigarettes and using tobacco products vary with location. ValuePenguin measured the economic fallout of smoking by comparing income levels, excise taxes, quality access to health care and insurance costs.
Poor access to quality health care and low median incomes in West Virginia make it the most expensive state for smokers. While excise taxes in West Virginia are comparably lower than in much of the rest of the country, high rates of preventable hospital stays increase the chances of a typical smoker spending even more money because of tobacco use.
Indeed, no matter the location, the cost of health and life insurance is higher for consumers who smoke cigarettes. ValuePenguin found that people in states with the highest percentages of tobacco users pay $97 more a year for marketplace health insurance plans than typical policyholders in states with the lowest rates of smokers. Further, smokers pay 215% more for life insurance on average than people who don't use tobacco.
Key findings
- The most expensive state for smokers is West Virginia. While excise taxes per pack of cigarettes are on the lower end, quality access to health care, health insurance expenses and income are among the worst in the U.S.
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The financial costs of smoking in Utah are likely to be less severe than in the rest of the country. Utah's young population, above-average median income and quality access to health care mean the state's residents are in a stronger position to absorb higher insurance expenses that result from smoking.
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The quality of medical care is lower in the places with the largest smoking populations. The ratio at which patients experience preventable hospital stays is 51% higher in the states with the most smokers compared to the states with the least.
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The costs of health and life insurance are both higher in areas where there are many smokers. The average combined cost of health and life insurance for smokers equals 10% of a typical policyholder's median income — with a high of 19% in West Virginia.
West Virginia's low-earning, aging population makes it an expensive state for smokers
The most expensive state for smokers is West Virginia. West Virginia's population has a lower median household income than every other state in the U.S. (including the District of Columbia) except Mississippi. In the last five years, the household median income in West Virginia has averaged $63,680 annually — $22,018 less than the average across the 50 states and D.C. during the same time. However, unlike in Mississippi, the age of the population in West Virginia is older.
State | Median age | Median income |
|---|---|---|
| Maine | 44.7 | $76,227 |
| Vermont | 42.9 | $81,233 |
| West Virginia | 42.5 | $63,680 |
| Florida | 42.0 | $80,286 |
| Connecticut | 41.0 | $113,031 |
| Pennsylvania | 40.8 | $84,849 |
| Delaware | 40.6 | $90,092 |
| Montana | 39.9 | $74,190 |
| Michigan | 39.7 | $78,400 |
| Wisconsin | 39.5 | $80,674 |
| South Carolina | 39.4 | $73,520 |
| Alabama | 39.0 | $69,842 |
States ordered by oldest median age among those with the worst ValuePenguin smoking scores.
In fact, the median age in West Virginia (42.5 from 2015 to 2019) is in the bottom 25% for oldest median age. relative to the entire country. Moreover, its elderly population — the percentage of people 60 and older — is also in the bottom 25% of states with the largest shares of people 60 and older. According to the U.S. Census Bureau, 22% of the state's population falls into this category.
As one ages, health care expenses increase. And health problems resulting from smoking only add to potential sources of growing costs. Health insurance is already more expensive in West Virginia, on average, than in the rest of the country. With an average statewide premium of $905 a month for a marketplace plan, a high expenditure floor only grows — and with it, the incomes of West Virginians are affected even more.
More than 25% of West Virginia's adult population are smokers, meaning that these disadvantageous economic and demographic factors stand to impact a larger portion of the state's residents.
Conversely, the least expensive place to be a smoker is Utah. Health insurance in Utah is affordable, as the average cost of coverage is $418 per month for a marketplace plan. This puts Utah's cost in the cheapest quarter of the states. At the same time, quality of care and the median age of the population converge positively and form an environment where the number of trips to a care facility is more likely to be lower.
Rank | State | ValuePenguin smoking score | Smoking population | Median age | Elderly population | Median income | Excise taxes | Cost of health insurance | Preventable hospital stays (per 1,000) |
|---|---|---|---|---|---|---|---|---|---|
| 1 | Utah | 22 | 8.7% | 30.8 | 13% | $91,292 | $1.70 | $418 | 31 |
| 2 | Virginia | 21 | 15.4% | 38.2 | 18% | $101,746 | $0.60 | $595 | 46 |
| 2 | Colorado | 21 | 14.8% | 36.7 | 17% | $96,970 | $1.94 | $545 | 32 |
| 2 | North Dakota | 21 | 18.6% | 35.1 | 17% | $85,476 | $0.44 | $459 | 49 |
| 2 | California | 21 | 11.0% | 36.5 | 16% | $106,916 | $2.87 | $566 | 35 |
| 6 | Idaho | 20 | 14.5% | 36.4 | 18% | $73,810 | $0.57 | $491 | 30 |
| 6 | Georgia | 20 | 17.1% | 36.7 | 16% | $82,406 | $0.37 | $557 | 54 |
| 6 | District of Columbia | 20 | 14.3% | 34 | 14% | $127,890 | $4.94 | $490 | 48 |
| 9 | Alaska | 19 | 19.1% | 34.3 | 15% | $98,606 | $2.00 | $805 | 37 |
| 9 | Nevada | 19 | 16.6% | 38 | 18% | $81,496 | $1.80 | $468 | 44 |
| 9 | Washington | 19 | 13.4% | 37.7 | 18% | $98,983 | $3.03 | $527 | 31 |
| 12 | Nebraska | 18 | 16.0% | 36.5 | 17% | $80,208 | $0.64 | $761 | 43 |
Preventable hospitalizations are a pressing issue for states with many smokers, especially when medical costs are high
By examining the health- and economic-related factors across smoking and nonsmoking populations, ValuePenguin's researchers uncovered clear disparities in the income levels, health care costs and access to quality care of the two groups.
Sorted by smoking populations, 13 states make up the bottom 25% of the data set (the states with the highest percentages of smokers). The median age of the populations in these states is not very different from the median age in areas with smaller groups of smokers. However, the residents are more likely to have low incomes: the median household income in states with the most smokers is $73,581 — $28,352 less than the median in the states with the smallest shares of smokers).
Health care expenditures are also higher in areas with more smokers. The average cost of health insurance in the states with the largest shares of smokers is $621 a year. This is $97 more expensive a year than in states with the fewest smokers.
Finally, residents of states with large smoking populations are more likely to experience a higher number of preventable hospital stays — which is considered a metric of health care access and quality of care. The rate of preventable hospital stays is 51% higher in the states with the largest smoking populations than in those with the smallest. Combined with low incomes and high health insurance costs, medical care adds to the economic strain that's more likely to affect smoking populations.
State | Smoking population | Median income | Cost of health insurance | Preventable hospital stays (per 1,000) |
|---|---|---|---|---|
| West Virginia | 25.1% | $63,680 | $905 | 66 |
| Kentucky | 24.4% | $70,144 | $549 | 73 |
| Arkansas | 22.7% | $66,557 | $503 | 59 |
| Louisiana | 22.0% | $71,001 | $646 | 70 |
| Mississippi | 21.7% | $62,835 | $600 | 68 |
| Tennessee | 21.4% | $74,750 | $661 | 62 |
| Ohio | 21.3% | $76,958 | $501 | 56 |
| Missouri | 20.8% | $76,060 | $609 | 54 |
| Indiana | 20.8% | $75,025 | $505 | 53 |
| Alabama | 20.7% | $69,842 | $668 | 62 |
| Oklahoma | 20.1% | $72,695 | $652 | 59 |
| Michigan | 19.6% | $78,400 | $472 | 49 |
While the cost of health insurance varies geographically, life insurance rates are uniformly much higher for smokers no matter where they live
Another element to consider in the cost of smoking is the cost of life insurance coverage. Unlike with other forms of insurance, the cost of life insurance is not determined by location. Smokers across the U.S. pay an average of 215% more for coverage than someone who doesn't use tobacco.
The elevated cost of life insurance for smokers means that policyholders pay a larger part of their incomes toward higher premiums. Higher insurance costs present the largest problem for lower-earning communities — especially when factoring in multiple forms of coverage.
In West Virginia, the most expensive state for smokers, high life and health insurance costs take up 19% of the median income. Since life insurance isn't mandatory, such high rates could dissuade people from purchasing and maintaining a policy if they can't find cheap coverage.
The following table shows the total cost of life and health insurance relative to income for smokers and nonsmokers. The table is ordered by the share of income that smoking life insurance policyholders pay, from largest to smallest.
State | Cost of life and health insurance (nonsmokers) | Percentage of income | Cost of life and health insurance (smokers) | Percentage of income |
|---|---|---|---|---|
| West Virginia | $11,314 | 18% | $12,262 | 19% |
| Wyoming | $11,002 | 13% | $11,950 | 15% |
| Iowa | $9,821 | 13% | $10,769 | 14% |
| Mississippi | $7,654 | 12% | $8,602 | 14% |
| Alabama | $8,474 | 12% | $9,422 | 13% |
| Nebraska | $9,588 | 12% | $10,536 | 13% |
| Louisiana | $8,210 | 12% | $9,158 | 13% |
| Oklahoma | $8,280 | 11% | $9,228 | 13% |
| North Carolina | $8,741 | 11% | $9,689 | 13% |
| Vermont | $9,238 | 11% | $10,186 | 13% |
| Tennessee | $8,393 | 11% | $9,341 | 12% |
| South Dakota | $8,167 | 11% | $9,115 | 12% |
Premiums are for the life and health insurance for a 35-year-old policyholder.
Methodology
ValuePenguin created a composite score to measure the most and least expensive places for smokers. The resulting ValuePenguin smoking scores comprise seven variables. Researchers evaluated the cost of smoking according to its effect on the overall finances of life insurance policyholders. Accordingly, the composite scores in this study comprise each state's:
- Percentage of smokers
- Median age
- Percentage of population 60 or older
- Median income
- Cigarette excise tax
- Preventable hospital stays
- Health insurance cost
Researchers collected age and income data from the U.S. Census Bureau's five-year estimates (2015-19) from its American Community Survey. The Centers for Disease Control and Prevention’s State Tobacco Activities Tracking and Evaluation (STATE) System supplied the state-level figures on adult smokers and excise taxes — the newest available data corresponding with 2018.
Preventable hospital stays were gathered from the County Health Rankings, while the cost of health insurance was compiled from public use files (PUF) on the Centers for Medicare & Medicaid Services website.