Nicotine and the life insurance medical exam

Providers use nicotine tests to assess the risk of insuring you. Find out how long nicotine stays in your system and what kinds of tobacco use affect your rates.

Rebecca Shoenthal author photoAmanda Shih author photo


Rebecca Shoenthal

Rebecca Shoenthal

Licensed Insurance Expert

Rebecca Shoenthal is an insurance editor and licensed Life, Health, and Disability agent at Policygenius in New York City. Previously, she worked as a nonfiction book editor. She has a B.A. in Media and Journalism from the University of North Carolina at Chapel Hill.


Amanda Shih

Amanda Shih

Editor & Licensed Insurance Expert

Amanda Shih is an insurance editor and licensed Life, Health, and Disability agent at Policygenius in New York City. Her work has appeared in Slate, Lifehacker, Little Spoon, and J.D. Power.

Updated February 4, 2021|6 min read

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When applying for life insurance, you’ll be asked if you smoke. And during the life insurance medical exam, you’ll be subject to a nicotine test. If you test positive, the insurance company will classify you as a smoker, which means you’ll pay more for life insurance than a non-smoker.

But what does an underwriter count as tobacco use and how long does nicotine stay in your system? Smokeless tobacco — such as chewing tobacco — and nicotine replacement products — including gum and patches used to quit smoking — still count against you. These products, cigarettes, and cigars all leave traces of nicotine or cotinine in your blood and urine for more than one week and up to one month, respectively. Read on to learn how a positive nicotine test can increase your life insurance rates, how to get the most affordable premiums if you use tobacco, and how long former smokers must wait before getting nonsmoker prices. 

Key Takeaways

  • Nicotine can show up in a screening almost a month after your last tobacco use

  • Secondhand smoke won’t show up on a nicotine test, but chewing tobacco and nicotine patches or gum will

  • Smokers pay two to three times more for life insurance than non-smokers

  • Insurers can cancel your policy if you lie about your tobacco use when applying

Why life insurance companies test for nicotine

According to the CDC, smoking is the leading cause of preventable disease, disability, and death in America. Life insurers use nicotine tests and questions about your smoking history to evaluate the risk of issuing you a policy. The higher life insurance premiums you’re charged as a smoker are the provider’s way of offsetting that risk.

How life insurers test for nicotine

When you apply for life insurance, you’ll be asked if you use tobacco products and when you last used them. That includes cigarettes, vaping, and any smokeless tobacco products. Be honest: If the insurer finds out you lied on your application, that’s fraud, and they could decline your application, cancel an existing policy or refuse to pay the death benefit to your loved ones after you die.

The next step in the underwriting process is a paramedical exam, which tests not just for nicotine, but also for cotinine — a byproduct of your body processing nicotine that stays in your blood even after nicotine has left your system.

How nicotine affects your life insurance rates

Life insurance companies look at your health, family medical history and your hobbies to give you a health classification and set your monthly premium.

Insurers have classifications specifically for smokers. So if you’d normally be classified as Preferred because you are generally in good health, if you smoke, you’d be classified as Preferred Tobacco or Preferred Smoker. This is the insurer’s way of saying that you otherwise fit the Preferred risk profile, but there’s a likelihood that you’ll experience health issues associated with your smoking habit. Smoker ratings can be two to three times higher than nonsmoker ratings.

Sample monthly premiums for a $500,000/20-year policy, smoker vs nonsmoker

Age Monthly premium (Smoker)Monthly premium (Nonsmoker)

Methodology: Rates are calculated male and female non-smokers obtaining a 20-year, $500,000 term life insurance policy with Preferred Tobacco and Preferred health ratings. Quotes are based on a composite of policies from AIG, Banner, Brighthouse, Lincoln, Mutual of Omaha, Pacific Life, Protective, Prudential, SBLI, and Transamerica and may vary by carrier, term, coverage amount, health class, and state. Not all policies are available in all states. Rate illustration valid as of 10/08/2021.

Every insurance company evaluates applicants differently, so whether or not you smoke,  it’s important to compare quotes from multiple providers to make sure you’re getting the most affordable policy.

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Why you shouldn’t lie about your nicotine use

If you lie about your nicotine use, somehow pass the medical screening without it showing up in a nicotine test, and are issued a nonsmoker policy, you could be putting your family at risk.

The first two years after your policy goes in force are known as the contestability period. If you die during that period, the insurance company has the right to go through your medical records and application materials again. If they suspect that you lied about something on your application that affected their ability to insure you — for example, saying you didn’t smoke when you actually did — they can cancel your policy.

This doesn’t just apply to the contestability period. Many policies include language that allows providers to deny the death benefit or cancel the policy over fraudulent statements at any time, even past the first two years.

If you lie on your application, the best-case scenario for your beneficiaries is that the provider delays the payment of the death benefit while they investigate. The worst-case scenario is the life insurer declines to pay out at all if your death is deemed tobacco-related.

How long does nicotine stay in your system?

Signs of nicotine stay in your blood for up to three days, but cotinine — what nicotine metabolizes into and a sure sign that nicotine was present in the body — can remain in your blood for longer than a week. For a urine test, it can take almost a month to get all signs of smoking out of your system.

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Will secondhand smoke show up on your life insurance nicotine test?

According to the CDC, there are known health effects of secondhand smoke. But secondhand smoke from a family member or coworker is unlikely to show up on your nicotine test.

While secondhand smoke isn’t good for you, you won’t absorb the amount of nicotine through secondhand exposure that you would as a smoker or user of other tobacco products, and it won’t show up in your blood test. If a nicotine test is positive, it’s because that person recently used tobacco.

Will chewing tobacco show up on your life insurance nicotine test?

Chewing tobacco contains a high amount of nicotine, so if you’re a regular or even occasional user, you’ll likely test positive for nicotine or cotinine. Even though you aren’t technically smoking, you’ll still be assigned a smoker classification because the health risks are similar to cigarette use.

Will nicotine gum or the nicotine patch show up on your life insurance nicotine test?

Smoking cessation products that help you quit — like nicotine patches or nicotine gum — contain enough nicotine that they’ll show up on nicotine tests. And even though these products ostensibly help you quit smoking, they’re still categorized as tobacco use by most life insurance companies.

Some insurers are more lenient than others and will give special consideration to smoking cessation products provided there isn’t any other tobacco use involved. Other insurers include cigarette smoking and nicotine substitutes (e-cigarettes, nicotine patches, and other smoking cessation products) under the same guidelines and classify users accordingly. If you’re using nicotine gum or a patch, it’s important to choose an insurer who will look favorably on your efforts to quit.

Can you quit smoking cold turkey and pass your life insurance nicotine test?

If you quit smoking several weeks before your life insurance medical exam, there is a chance that your nicotine and cotinine screenings will come back negative. Still, quitting less than a year before your medical exam is unlikely to earn you more affordable premiums. Most providers don’t offer you nonsmoker rates until you’ve gone a year or more without using tobacco.

Even if your screen comes back clear, be honest with your insurer about the day you quit smoking. If it’s recent, you won’t get nonsmoker rates, but by lying you’re committing fraud and risk having your policy canceled and leaving your family unprotected.

How former smokers can get nonsmoker rates on life insurance

If you want nonsmoking rates, you need to stop using tobacco — for good. Once you’ve been nicotine-free for several years, you can either ask your insurance company for rate reconsideration, which would involve another drug test, or you can reapply for a new policy.

An independent agent, like the insurance advisors at Policygenius, can help you get a policy that works for you. They aren’t beholden to a single insurer and will allow you to shop around and find the best life insurance company for all of your habits and health needs.


Does COVID-19 affect the life insurance application process or eligibility?

Due to the ever-changing nature of the coronavirus pandemic, some insurers are modifying processes and/or imposing coverage restrictions on certain health conditions or age groups. Speak to a Policygenius agent for free to find out how to get the most affordable policy.

Do life insurance exams detect nicotine?

The life insurance medical exam tests for nicotine and cotinine in your blood and urine. If you test positive for either, you will have to pay smoker rates.

How does a life insurance company know if you smoke?

Life insurance companies know if you smoke because they test for tobacco byproducts during the medical exam. They also can request access to your medical records that can show smoking history. If you lie about your smoking habits, you may be denied coverage.

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