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.

Logan SachonAmanda Shih author photo

Logan Sachon & Amanda Shih

Published July 29, 2020


  • 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 four times more for life insurance than non-smokers

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

When you’re applying for life insurance, you’ll be asked if you smoke. During the life insurance medical exam, you’ll be subject to a nicotine test. If you test positive, you’ll be classified as a smoker, which means you’ll pay more for your 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 still counts against you, and so will nicotine replacement products you’d typically use to quit smoking. Smokeless tobacco, nicotine gum or patches, cigarettes, and cigars leave traces of nicotine or cotinine in your blood for more than one week and in your urine for almost one month. Read on to learn how a positive nicotine test will affect your life insurance.

Why life insurance companies test for nicotine

According to the CDC, smoking is the leading cause of preventable disease, disability, and death in America, which is why 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 the last time any use took place. That includes cigarettes, vaping, and any smokeless tobacco products you use. Be honest: If the insurer finds out you lied on your application, that’s fraud, and they could cancel your policy or refuse to pay the death benefit to your loved ones after you die.

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

If you said you were not a smoker on your application and you test positive for nicotine during the medical exam, you still may be offered a plan at smokers’ rates, but it’s also possible that you could be declined for lying.

How nicotine affects your life insurance rates

Life insurers look at your health history and your hobbies or habits to give you a health classification and set your monthly premiums.

Insurers have classifications specifically for smokers. Say you’d normally be classified as Preferred; 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 four 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)

Sample premiums based on Preferred Tobacco and Preferred health ratings for a 20-year term life insurance policy; quotes based on policies offered by Policygenius in 2020.

Every insurer evaluates applicants differently, so smoker or not, it’s important to compare quotes from multiple providers to make sure you’re getting the best and 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 if you’re past its 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 declining 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 in the body and a sure sign that nicotine was present — 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, it’s likely that you’ll 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 — things 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 classifies 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 cold turkey several weeks before your life insurance medical exam, there is a chance that your nicotine and cotinine screenings will come back negative. Still, quitting any 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 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 policies.

An independent agent, like the insurance advisors at Policygenius, can help you get a policy that works for you. They won’t be 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.

Insurance Expert

Logan Sachon

Insurance Expert

Logan Sachon is the co-founder of The Billfold, a groundbreaking personal finance site for millennials that was named one of Time's 25 Best Blogs of 2012. Her work has been published in New York Magazine, Glamour, The Guardian, BuzzFeed and more.

Insurance Expert

Amanda Shih

Insurance Expert

Amanda Shih is an insurance editor at Policygenius in New York City. Previously, she worked in nonfiction book publishing and freelance content marketing. Amanda has a B.A. in literature and communication from New York University.

Policygenius’ editorial content is not written by an insurance agent. It’s intended for informational purposes and should not be considered legal or financial advice. Consult a professional to learn what financial products are right for you.

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