There is no federal penalty for not having health insurance. Congress zeroed out the Affordable Care Act’s individual mandate penalty starting with the 2019 tax year, and it has stayed at zero since. Five states — California, Massachusetts, New Jersey, Rhode Island, and Vermont’s neighbor plus the District of Columbia — still charge their own penalties, and the amounts can reach several thousand dollars a year for a household that goes uninsured.
The Federal Penalty Is Zero
The individual mandate is still in the Internal Revenue Code, but both the percentage-of-income calculation and the flat dollar amount are set to zero, so there is no federal financial consequence for being uninsured.1Office of the Law Revision Counsel. 26 U.S. Code 5000A – Requirement to Maintain Minimum Essential Coverage Form 1040 has no penalty line for lacking coverage, and the IRS does not assess one.
This is true for every tax year from 2019 forward. If you live in a state without its own mandate, going uninsured produces no direct tax bill at either level. Medical debt from an uninsured hospital visit is a separate risk, but the tax consequence is nothing.
States That Still Charge a Penalty
Five states and the District of Columbia stepped in after the federal change. Each requires residents to carry minimum essential coverage or pay on their state tax return:
- Massachusetts, which reinstated its penalty in 2019 (the state had a mandate before the ACA existed).
- New Jersey, starting with the 2019 tax year.
- The District of Columbia, also starting in 2019.
- California, starting with the 2020 tax year.
- Rhode Island, also starting with the 2020 tax year.
Vermont requires residents to report their insurance status on the state return but does not charge a penalty. No other states impose one.
How Much You Owe by State
Most mandate states borrow the old federal formula: you owe the greater of a flat dollar amount per person or a percentage of household income above the filing threshold, capped at the cost of an average bronze marketplace plan. Massachusetts uses income brackets instead.
California
The penalty is 2.5% of household income above the state filing threshold, or a flat amount per person, whichever is higher. For the 2025 tax year, the flat amount is $950 per adult and $475 per child under 18.2Franchise Tax Board. Personal Health Care Mandate The total cannot exceed the statewide average bronze plan premium for your household size. For 2026, Covered California puts that average at $420 per month for an individual, with a maximum of $2,100 per month for a household of five or more uninsured members.3Covered California. 2026 Individual Shared Responsibility Penalty Calculation The penalty is reported on Form FTB 3853.
Massachusetts
Massachusetts ties the penalty to income as a percentage of the Federal Poverty Level. At or below 150% of FPL, you owe nothing. Above that, the tax year 2026 schedule for individuals is:4Mass.gov. TIR 26-1 – Individual Mandate Penalties for Tax Year 2026
- 150.1–200% FPL: $312 per year
- 200.1–250% FPL: $612 per year
- 250.1–300% FPL: $912 per year
- 300.1–400% FPL: $1,404 per year
- Above 400% FPL: $2,532 per year
For married couples, the penalty is the sum of each spouse’s individual amount. No individual’s penalty can exceed half the cost of the lowest-priced plan available through the state’s Health Connector.4Mass.gov. TIR 26-1 – Individual Mandate Penalties for Tax Year 2026
New Jersey
New Jersey follows the flat-fee-or-percentage model. The penalty is the greater of a flat dollar amount or 2.5% of household income above the federal filing threshold, capped at the statewide average annual bronze plan premium. For the most recent published year, the flat minimum is $695 per uninsured adult, and the maximum single-person penalty is $4,908.5State of New Jersey. Shared Responsibility Payment
Rhode Island
For the 2025 tax year, Rhode Island’s flat rate is $57.92 per adult and $28.96 per child per month, or 2.5% of modified adjusted gross income above the tax filing threshold, whichever is greater. The flat dollar penalty maxes out at $2,085, and the overall penalty is capped at $357 per month based on the average bronze plan cost.6Rhode Island Division of Taxation. Individual Health Insurance Mandate for Rhode Island Residents
District of Columbia
DC’s penalty mirrors the old federal formula. For the 2025 tax year, it is the greater of $795 per adult and $397.50 per child (up to $2,385 per family) or 2.5% of household income above the federal filing threshold.7DC Health Link. Get Covered. Stay Covered. The amounts adjust annually.
Exemptions That Can Erase the Penalty
Every mandate state offers exemptions. The specifics vary, but the same core categories show up in each.
A short gap in coverage — less than three consecutive months during the year — typically qualifies for an automatic exemption. Under the federal definition most states follow, if you have coverage for even one day of a month, the whole month counts as covered.8CMS. Exemption Information if You Had a Gap in Health Coverage A gap of three months or longer disqualifies you from this exemption for every uninsured month in the gap.
Other common exemptions:
- Income below the state filing threshold. If you are not required to file, you owe no penalty.
- Affordability hardship. If the cheapest available coverage would cost more than a set percentage of your household income, you can claim an exemption. The federal affordability threshold for 2026 is 9.96% of household income, and most states use a similar benchmark.
- Membership in a recognized religious sect that objects to insurance.
- Incarceration.
- General financial hardship, including bankruptcy, eviction, or domestic violence.
Some exemptions are claimed directly on the state tax return. Others, especially marketplace-granted hardship exemptions, require applying through the health insurance exchange in advance and receiving an exemption certificate number to enter at filing time.
What Counts as Qualifying Coverage
Not every health plan satisfies a mandate. State laws use the federal definition of “minimum essential coverage,” which includes employer-sponsored plans, marketplace plans, Medicare, most Medicaid coverage, CHIP, TRICARE, and certain veterans health programs.9CMS. Minimum Essential Coverage
Two popular alternatives do not qualify. Health care sharing ministries, where members pool money to cover each other’s medical bills, are not recognized as minimum essential coverage. Short-term limited-duration plans also fall outside the definition. California and New Jersey go further and ban the sale of short-term plans entirely. Relying on either in a mandate state means you owe the penalty as if you had no coverage.
Reporting Coverage at Tax Time
Federal penalty or not, coverage information still flows through the tax system. Insurers, employers, and government programs send 1095-series forms each year: Form 1095-A for marketplace enrollees, 1095-B from insurers and programs like Medicare or CHIP, and 1095-C from large employers.10Internal Revenue Service. Questions and Answers About Health Care Information Forms for Individuals Keep them with your tax records.
In mandate states, the state return has its own coverage section. California uses Form FTB 3853 to claim exemptions or calculate the penalty.11Franchise Tax Board. Instructions for California Form 3853 – Health Coverage Exemptions and Individual Shared Responsibility Penalty New Jersey collects coverage information directly on the NJ-1040. Each mandate state’s tax agency publishes instructions for its own calculation, and you will need to either confirm full-year coverage or identify the uninsured months and compute what you owe.