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 $0 since. Five states — California, Massachusetts, New Jersey, Rhode Island — plus the District of Columbia still charge their own penalty on the state tax return, and the bill can run into the thousands depending on income and household size.
The Federal Penalty Is $0
The individual mandate itself is still in the tax code, but both the percentage-of-income calculation and the flat dollar amount are set at 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 Your federal Form 1040 has no penalty line for lacking coverage, and the IRS will not assess one.
That has been true for every tax year from 2019 forward. If you live outside the handful of states listed below, going uninsured carries no direct tax consequence. The financial risk is medical, not fiscal: an uninsured hospital stay can cost far more than any penalty ever did.
States That Still Charge a Penalty
Five states and the District of Columbia stepped in after Congress zeroed the federal penalty. Each requires residents to carry minimum essential coverage or pay on their state tax return.
- Massachusetts (penalty reinstated in 2019; the state had its own mandate before the ACA)
- New Jersey (2019 tax year)
- District of Columbia (2019 tax year)
- California (2020 tax year)
- Rhode Island (2020 tax year)
Vermont asks residents to report their insurance status on the state return but does not fine anyone for being uninsured. No other state currently enforces a mandate penalty.
How Much You’d Owe by State
Four of the six jurisdictions borrow the old federal formula: you owe the greater of a flat dollar amount per person or a percentage of household income above the state filing threshold, capped at the cost of an average bronze marketplace plan. Massachusetts uses income brackets instead.
California
California charges 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 put 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 You report any penalty on Form FTB 3853 with your state income tax return.
Massachusetts
Massachusetts uses a sliding scale tied to income as a percentage of the Federal Poverty Level. At or below 150% FPL, you owe nothing. Above that, the penalty climbs through income bands. For tax year 2026, the 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
Married couples owe the sum of each spouse’s individual penalty. For any one person, the amount cannot 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 uses 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. In the most recent figures published by the state, the flat minimum is $695 per uninsured adult and the maximum penalty for a single individual is $4,908.5State of New Jersey. Shared Responsibility Payment
Rhode Island
Rhode Island also uses the flat-fee-or-percentage approach. For 2025, the flat rate is $57.92 per adult and $28.96 per child per month. The percentage-of-income calculation is 2.5% of modified adjusted gross income above the tax filing threshold. 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, the amount 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 figures are adjusted annually.
Exemptions That Can Wipe Out the Penalty
Every mandate state recognizes a set of exemptions that can reduce or eliminate what you owe.
A short gap in coverage of less than three consecutive months typically qualifies for an automatic exemption. Under the federal definition most states follow, having coverage for even one day of a month means 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.
- Affordability hardship, where the cheapest available coverage would cost more than a set percentage of household income. The federal affordability threshold for 2026 is 9.96%, and most states use a similar benchmark.
- Membership in a recognized religious sect that objects to insurance.
- Incarceration.
- General financial hardship such as bankruptcy, eviction, or domestic violence.
Some exemptions are claimed directly on your state tax return. Others, particularly marketplace-granted hardship exemptions, require applying through the health insurance exchange in advance and getting an exemption certificate number to report at filing.
What Counts as Qualifying Coverage
Not every plan satisfies the mandate. Federal law and state mandates use the term “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 count. Health care sharing ministries, where members pool money to cover each other’s medical expenses, are not recognized as minimum essential coverage. Short-term limited-duration plans also fall outside the definition. California and New Jersey ban the sale of short-term plans entirely. If you rely on either of these in a mandate state, you will owe the penalty as if you had no coverage at all.
Avoiding Next Year’s Penalty
If you want to get covered and stop the clock, timing matters. The federal marketplace and most state exchanges only accept new enrollments during Open Enrollment. For 2026 coverage, that window runs from November 1, 2025, through January 15, 2026.10Centers for Medicare & Medicaid Services. Marketplace 2026 Open Enrollment Fact Sheet
Outside that window, you can only enroll if you experience a qualifying life event that triggers a Special Enrollment Period. These include losing existing coverage, getting married or divorced, having or adopting a child, moving to a new area, losing Medicaid or CHIP eligibility, and turning 26 and aging off a parent’s plan.11HealthCare.gov. Qualifying Life Event (QLE) A Special Enrollment Period typically gives you 60 days from the event to pick a plan. Miss both windows in a mandate state and you can owe a full year’s penalty before you’re eligible to enroll again.