Whether you have to carry health insurance depends on where you live. There is no longer a federal penalty for going without coverage, but a handful of states and Washington, D.C. have their own requirements and can charge a penalty on your state tax return. This guide explains where coverage is required, how state penalties generally work, and what counts as qualifying coverage.
Is Health Insurance Required by Federal Law?
No. There is no federal penalty for not having health insurance. The federal “individual mandate” penalty under the Affordable Care Act was reduced to $0 starting in 2019.
HealthCare.gov confirms that the federal fee for not having health insurance no longer applies. It only applied to plan years 2018 and earlier. That means you won’t owe anything on your federal tax return for being uninsured, but state rules may still apply.
Which States Require Health Insurance?
As of 2026, five places require most residents to have health insurance and can charge a penalty if they don’t: Massachusetts, New Jersey, California, Rhode Island, and Washington, D.C.
- Massachusetts has had its own requirement since 2006, well before the federal one.
- New Jersey and Washington, D.C. started their requirements in 2019, right after the federal penalty went to $0.
- California and Rhode Island started theirs in 2020.
Vermont also has a coverage requirement, but it doesn’t charge a penalty. Vermont’s state tax return asks whether you had coverage, and that information is used to help connect uninsured residents with coverage options.
State laws can change, so confirm the current rules with your state’s tax agency or health insurance marketplace before filing.
How Do State Health Insurance Penalties Work?
In states with a penalty, it’s generally charged on your state income tax return for each month you or your dependents went without qualifying coverage and didn’t have an exemption.
Each state sets its own formula. Several of them are based on the old federal approach: either a flat amount per person or a percentage of household income, whichever is higher. Some states also cap the penalty at the cost of an average plan. Exact amounts change from year to year and vary by state, so use your state’s official calculator or tax instructions for current figures.
Are There Exemptions From State Coverage Requirements?
Yes. Every state with a penalty offers exemptions, and the categories vary by state. Common examples include:
- Having income below the state’s tax filing threshold
- Coverage being unaffordable based on your income
- A short gap in coverage
- Certain hardships
- Membership in a qualifying religious group
How you claim an exemption also varies. Some are claimed directly on the state tax return, and others require an application through the state’s marketplace. Check your state’s official exemption page for the rules that apply to you.
What Counts as Qualifying Coverage?
Most comprehensive health coverage counts toward state requirements, including:
- Job-based plans
- Marketplace plans
- Medicare and Medicaid
- CHIP
- Most military and veteran coverage
Some types of coverage may not count. These can include short-term health plans, fixed indemnity plans, and some health sharing ministries, depending on the state. If you’re not sure whether your plan qualifies, check with the plan and your state before relying on it to avoid a penalty.
If Your State Doesn’t Require Coverage, Do You Still Need It?
Even where coverage isn’t required by law, going without health insurance means paying the full cost of any care you need. A serious illness or injury can lead to very large medical bills.
Car insurance works the other way: almost every state sets a legal minimum for auto coverage, while health insurance is required in only a few places. Whether or not your state requires it, financial help through the Marketplace may make coverage more affordable than you’d expect. See practical ways to lower your health insurance costs for where to start.
Timing matters too. You can generally only buy a Marketplace plan during open enrollment or after a qualifying life event. In states that use HealthCare.gov, open enrollment for 2027 coverage runs from November 1, 2026, through January 15, 2027. State-run marketplaces, including those in most states with a coverage requirement, may use different dates.
Frequently Asked Questions
Is there a penalty for not having health insurance in 2026?
There’s no federal penalty. If you live in Massachusetts, New Jersey, California, Rhode Island, or Washington, D.C., you may owe a penalty on your state tax return unless you had qualifying coverage or an exemption. Vermont requires coverage but doesn’t charge a penalty.
Do I have to pay a state penalty if I was uninsured for only part of the year?
It depends on your state. Penalties are generally figured by month, and some states allow a short gap without a penalty. Check your state’s tax instructions for how it treats partial-year gaps.
Does a short-term health plan satisfy state coverage requirements?
Often not. Short-term plans usually don’t meet the definition of qualifying coverage, and some states restrict or don’t allow them. Confirm with your state before relying on any plan that isn’t a standard comprehensive policy.
If I move to a state with a mandate, when does the requirement start?
The requirement generally applies for the months you’re a resident of that state. Moving to a new state is usually a qualifying life event, which can let you enroll in a new plan outside of open enrollment. Check your new state’s rules and marketplace deadlines soon after you move.
This article is for informational purposes only and does not constitute insurance, legal, or financial advice. Insurance products, rates, and terms vary by state and insurer; consult a licensed agent or your policy documents before making coverage decisions.