Here's something most people don't realize until they apply for life insurance: your health doesn't just matter—it can literally double or triple what you pay for the exact same coverage. Two 35-year-olds applying for the same $500,000 policy might pay $30 per month or $90 per month, and the difference often comes down to a handful of health factors you can actually control.
Life insurance companies aren't being picky for fun. They're in the business of calculating risk, and your health is the biggest predictor of how long you'll live. The better your health, the lower their risk, and the less you'll pay. But the system isn't as mysterious as it seems. Understanding how insurers evaluate health—and what you can do about it—puts you in control of your rates.
Understanding Life Insurance Rating Classes
When you apply for life insurance, the underwriter assigns you a health classification that determines your rate. Think of it like credit scores, but for your body. Most companies use five main categories, though the names vary slightly between insurers.
Preferred Plus (sometimes called Preferred Elite or Preferred Select) is the gold standard. This classification goes to people in excellent health with ideal weight, good cholesterol and blood pressure numbers, no tobacco use, and no concerning family medical history. These folks get the absolute lowest rates—the prices you see advertised in those competitive quotes online. Only about 10-15% of applicants qualify for Preferred Plus.
Preferred is one step down, reserved for people in very good health but with minor issues—maybe you're 10-15 pounds over ideal weight, or you have slightly elevated cholesterol that's controlled with medication. You'll pay a bit more than Preferred Plus, but still significantly less than average rates. About 20-30% of applicants land here.
Standard Plus and Standard are where most people end up. Standard means you have average health and life expectancy—maybe you're moderately overweight, have blood pressure in the high-normal range, or take medications for common conditions. These are the baseline rates insurers use for pricing. If you're in decent health without major issues, you'll likely qualify for at least Standard rates.
Substandard (also called Table Rated) is for applicants with significant health concerns or complicated medical histories. This is where things get expensive. Substandard classifications use a table rating system, typically numbered 1-16 or lettered A-P. Each step adds 25% to your Standard rate. Table 1 means you'll pay 25% more than Standard. Table 4 means 100% more—your premiums literally double. If you've recently had a heart attack, been diagnosed with diabetes, or have a BMI over 40, you'll likely face table ratings.
The Health Conditions That Matter Most
Not all health issues carry equal weight with underwriters. Some conditions barely move the needle, while others can tank your rating or even lead to a denial. Here's what insurers care about most.
Smoking and tobacco use creates the single largest rate difference. We're talking 2-3 times higher premiums compared to non-smokers—sometimes more. A 35-year-old male non-smoker might pay $25 per month for a $500,000 20-year term policy, while a smoker pays $75 for identical coverage. Insurers define tobacco use broadly: cigarettes, cigars, chewing tobacco, and even vaping typically count. Most companies require 12 months of complete tobacco cessation before they'll offer non-smoker rates.
Your weight and BMI factor heavily into underwriting decisions. Insurers use Body Mass Index to assess risk based on your height and weight. Being 20-30 pounds overweight might drop you from Preferred to Standard. A BMI over 40 typically results in table ratings or coverage denial. The good news? Losing weight before applying directly improves your classification and rates.
Blood pressure and cholesterol are key metrics underwriters examine closely. For Preferred Plus classification, most insurers want blood pressure under 130/85 and total cholesterol under 220. High blood pressure or cholesterol that's well-controlled with medication usually won't disqualify you from decent rates, but uncontrolled readings will push you down the rating scale. If your numbers are borderline, it's worth spending a few months improving them before applying—the rate savings over 20-30 years can be substantial.
Serious medical conditions like heart disease, cancer, diabetes, and stroke have major impacts on your rating. The severity and how well-managed these conditions are matters enormously. Diabetes controlled through diet might result in Standard Plus rates, while insulin-dependent diabetes could mean Table 4 or higher. A heart attack within the past two years often results in a decline or extreme table rating, but if it happened 10 years ago and you've had no issues since, you might qualify for Standard or even Standard Plus. Cancer history is evaluated based on type, stage, and time since remission.
Mental health conditions are treated with increasing nuance by insurers. Well-managed depression or anxiety typically won't hurt your rating much, especially if you've been stable on medication. Recent hospitalizations for mental health crises, multiple suicide attempts, or severe bipolar disorder will result in table ratings or postponement until your condition stabilizes.
How to Improve Your Life Insurance Rating
The rating you get isn't set in stone—it's a snapshot of your health at the time you apply. Making strategic improvements before you apply can save you thousands of dollars over the life of your policy. Here's what actually works.
If you smoke or use tobacco, quitting is hands-down the most impactful change you can make. The catch is timing: most insurers require 12 months of verified non-use before they'll reclassify you. That means if you're serious about life insurance and currently smoke, your best move is to quit now and apply in a year. The premium savings—potentially 50-75% less—will more than compensate for the 12-month wait. Some people get nervous about waiting, but remember: the policy you buy will last 20-30 years. Twelve months is nothing in that context.
Weight loss, even moderate amounts, can bump you up a classification. Losing 15-20 pounds might move you from Standard to Standard Plus or from Standard Plus to Preferred. That translates to real money—potentially $10-20 per month in savings, which adds up to $2,400-$4,800 over a 20-year term. If you're close to a BMI threshold, consider delaying your application a few months while you work on weight loss. The rate improvement will be worth it.
Getting your blood pressure and cholesterol under control before applying makes a measurable difference. If your doctor has recommended medication and you've been putting it off, now's the time. Underwriters want to see that you're managing your health responsibly. Having 3-6 months of stable, improved readings on your medical record demonstrates you're a lower risk than someone with untreated elevated numbers.
Some insurers offer table shave programs that can improve your rating by 1-2 tables if you meet certain criteria. These programs consider factors beyond just medical conditions—things like having a high income, maintaining regular preventative care, being a lifetime non-smoker, or having a clean driving record. If you're facing a table rating, ask your agent whether the insurer has a table shave program and what factors they consider.
Shopping around with multiple insurers is crucial if you have any health issues. Different companies weight conditions differently, and some specialize in certain demographics or health profiles. One insurer might table rate your controlled diabetes while another offers you Standard rates. An independent broker who works with multiple carriers can shop your application to find the best fit for your specific situation.
Taking the Next Step
Your health classification isn't about judgment—it's about math. Insurers are calculating the statistical probability of paying out a claim, and they price accordingly. The system actually rewards you for taking care of yourself, which is one of the few areas of insurance where you have real control over what you pay.
If you're in good health, don't overthink it—apply for coverage and lock in your rates while you're healthy. If you have health concerns, don't assume you can't get affordable coverage. Many conditions are entirely insurable at reasonable rates, especially when they're well-managed. Work with an experienced broker who can guide you toward insurers that treat your specific situation favorably.
And if your health isn't where you want it to be? Consider whether a few months of focused improvement might save you thousands over the life of your policy. Sometimes the best time to apply for life insurance is after you've taken a few strategic steps to optimize your health classification. Your future self will thank you for the lower premiums.
