Individual and Family
Does Your State Require You to Have Health Insurance?
Updated on January 07, 2020
The Individual mandate law – which requires you to have health insurance – does not apply anymore in 2019 at the federal level, however there are a few states that have an individual mandate at the state level.
If you live in the following states, you may have to pay a tax penalty for not having health insurance:
- New Jersey
- Rhode Island
What is the individual mandate?
In the past if you went without Affordable Care Act (ACA) compliant health insurance for more than two months, you would have to pay a significant tax penalty.
According to Kaiser Health News, the penalty for going without health insurance in 2018 was $695 per uninsured adult or 2.5% of your income, whichever amount was higher.
Now that the individual mandate has been repealed there is not tax penalty at the federal level. However, some states have put their own individual mandate laws in place at the state level to encourage people to purchase health insurance.
Massachusetts’ individual mandate
According to mass.gov, Massachusetts has required its residents to have health insurance or pay a fine since 2006. Massachusetts officials have said to have reached coverage rates as high as 97.5% in the state, in part due to the mandate.
In this state, the tax penalty is based on income level in relation to the Federal Poverty Line (FPL). The FPL is placed at a certain income per year by the government. Your eligibility for subsidies, and in this case for a fine, is based what percentage your annual income is of the FPL.
For 2018, the FPL is $12,140 for an Individual and $25,100 for a family of four.
Source: 2018 HHS poverty guidelines
For 2019, those making $150 and under of the poverty line the individual responsibility penalty does not apply.
For those who make 150.1% to 200% of the FPL, their fine will be the equivalent to half of the lowest price ConnectorCare health insurance plan. ConnectorCare is Massachusetts’ health insurance marketplace.
Those making over 300% of the FPL will be charged half of the lowest priced bronze premium (which are based on the prices as of January 1, 2019).
Penalties for married couples (with or without children) will equal the sum of the individual penalties for each spouse.
New Jersey’s individual mandate
After the federal individual mandate was set to be repealed, New Jersey decided to put one in place with a tax penalty at the state level which takes effect in 2019.
If you do not have health insurance or if you do not qualify for an exemption, you may have to pay the tax penalty for every month that you go without the minimum essential coverage.
The tax penalty is generally based on your household income (which include the income of any dependents) as well as family size. However, the penalty capped at the cost of the average statewide premium for bronze health insurance plans.
According to nj.gov, for an individual, the minimum tax penalty is $695 and the maximum is $3,012 for 2019. For a family of 5 with a household income of $200,000 or below the minimum tax penalty is $2,085 and the maximum is $9,500.
If you are not required to file a tax return for 2019 in NJ, then you are exempt from paying this tax fine.
Washington D.C.’s individual mandate
After the federal mandate was set to be repealed, Washington D.C. put an individual mandate in place for the district as a part of their Get Covered, Stay Covered campaign. This tax penalty went into effect for the year of 2019.
According to dchealthlink.com, the tax penalty for going without the minimum essential coverage in Washington D.C. for 2019 is $695 per adult and $347.50 per child, up to $2,085 per family or 2.5% of the household income that is over the federal tax filing threshold, whichever is greater.
For instance, a family of 4 with a household income of $98,000 will have to pay a tax penalty of $2,085 per month for going without ACA-compliant health insurance.
You may qualify for an exemption to this tax for if you’ve experienced something such as a financial hardship, eviction, or pregnancy.
California’s Individual Mandate
California has also recently implemented an individual mandate law and impose the shared responsibility tax penalty for residents.
According to Covered California, the reasoning for restoring the individual mandate is a factor in keeping premiums on average 3.2% lower in the upcoming year. Covered California anticipates that this could leave to Californians saving an average of $167 per year on their health insurances premiums in 2020.
Those who choose not to purchase health insurance but can afford it, may be subjected to a tax penalty, which will be a part of their annual state tax filing. The penalty for Californians who go without health insurance may be 2.5% of household income or $696 per adult (this number will rise yearly with inflation), whichever is larger.
Rhode Island’s Individual Mandate
Starting in 2020, Rhode Island residents will also be subject to an individual mandate tax penalty if they go without coverage. Unless RI residents qualify for an exemption, they will have to pay a tax for going uninsured when they file their taxes in the following year.
The penalty for going uninsured in Rhode Island is the same as it would have been under the federal penalty. It will cost a family $695 for each uninsured adult and $347.50 for each uninsured child or 2.5% of the household income, whichever is greater. The maximum a household can be fined is $2,085 per family or – for the percentage of income calculation – the average cost of a bronze plan in Rhode Island.
Vermont’s individual mandate
Vermont lawmakers passed an individual mandate law that will go into effect in 2020, however they did not develop a penalty for those who go without health insurance.
This does not mean there will not be a penalty. If you live in Vermont, keep an eye out in case lawmakers do decide to develop and implement a penalty for those going without minimum essential coverage in the future.
How do I avoid the individual mandate tax?
To avoid this tax, you can enroll in a health insurance plan during the open enrollment period. For 2020 coverage, the national open enrollment period will take place from November 1st 2019 through December 15th 2019.
If you lose your insurance in the middle of the year, you may qualify for a special enrollment period. Or, depending on which state you live in, you may be able to enroll in short-term health insurance to help fill any coverage gaps you may experience throughout the year.
eHealth, the nation’s first and largest online health insurance brokerage, sells both major medical plans and short-term health insurance plans to help fulfill whatever your coverage needs may be. Enter your zip code where applicable on this page to get started!