Going without health insurance is not a federal crime, and there is no IRS penalty for doing so in 2026. But whether health insurance is mandatory in the US has a two-part answer that depends entirely on where you live. At the federal level, the individual mandate penalty was zeroed out starting in 2019. At the state level, five jurisdictions, California, Massachusetts, New Jersey, Rhode Island, and Washington D.C., still enforce their own coverage requirements with real financial consequences. Vermont has a mandate on record but does not currently impose a fine.
If the question "do I have to have health insurance" brought you here, the short answer is: it depends on your state. The rest of this guide explains the full picture, what changed federally, which states require coverage, how penalties are calculated, and what exemptions are available.
At a Glance: Health Insurance Requirements in 2026
| Topic | Key Facts |
|---|---|
| Federal mandate penalty | $0 since 2019; no IRS consequence for being uninsured |
| States with active financial penalties | CA, MA, NJ, RI, Washington D.C. |
| State with mandate but no fine | Vermont |
| States with no requirement | All other 44 states |
| Short gap exemption | Coverage gap under 63 days (fewer than 3 consecutive months) |
| Employer mandate threshold | Applies to employers with 50 or more full-time equivalent employees |
| Typical open enrollment window | November 1 through January 15 (most states) |
Is Health Insurance Required by Law? The Federal Answer
No. Health insurance is not legally required at the federal level as of January 1, 2019.
According to the IRS, the Tax Cuts and Jobs Act (TCJA), enacted in December 2017, reduced the federal individual shared responsibility payment to zero for tax year 2019 and all subsequent years. The legal requirement to maintain minimum essential coverage technically remains written into the Affordable Care Act (ACA), but without a financial penalty attached, there is no enforcement mechanism at the federal level.
The IRS also confirms that taxpayers no longer need to report health coverage status on their federal tax return, and no shared responsibility payment is owed for being uninsured.
So is it against the law to not have health insurance at the federal level? Technically, the ACA coverage requirement still exists in statute. But with no penalty, no form to file, and no IRS enforcement, the practical answer is no. For most Americans in most states, going uninsured is not illegal and carries no federal tax consequence.
Which States Still Require Health Insurance in 2026?
Five states and Washington D.C. actively enforce individual health insurance mandates through state tax penalties. Vermont has a mandate without a monetary fine.
California
California reinstated its individual mandate on January 1, 2020. All state residents must maintain minimum essential coverage for every month of the year or pay a penalty assessed by the California Franchise Tax Board when filing a state income tax return.
Per Covered California, the penalty for going uninsured for the full 2025 tax year (reported on the return filed in spring 2026) is at least $950 per adult and $450 per dependent child under 18. A family of four without coverage for the entire year faces a minimum penalty of $2,800. The penalty is also calculated as 2.5% of household gross income above the state filing threshold, and whichever amount is higher applies.
Residents report coverage status using FTB Form 3853.
Massachusetts
Massachusetts has enforced an individual mandate since 2006, predating the ACA by several years. Per Mass.gov TIR 26-1, most adults 18 and older with access to affordable coverage must maintain health insurance meeting the state's Minimum Creditable Coverage standards throughout 2026. The penalty is assessed monthly and calculated as a sliding-scale amount based on income and age, capped at 50% of the lowest-priced plan available to the individual. Residents with incomes at or below 150% of the federal poverty level are not subject to a penalty.
New Jersey
New Jersey enacted its Health Insurance Market Preservation Act in 2018. According to the New Jersey Division of Taxation, residents who lack minimum essential coverage must pay a Shared Responsibility Payment (SRP) when filing their state income tax return. The SRP is calculated based on household income and family size, and is capped at the statewide average annual premium for bronze-level health plans. Residents not required to file a New Jersey income tax return are automatically exempt.
Rhode Island
Rhode Island's individual mandate took effect on January 1, 2020. Per the Rhode Island Division of Taxation, residents who go without qualifying coverage for any month of the tax year may owe a shared responsibility payment penalty when filing their state personal income tax return. The penalty is calculated as the greater of 2.5% of modified adjusted gross income above the state filing threshold, or a flat dollar amount per uninsured person, capped at the average bronze plan premium in Rhode Island. A gap of fewer than three consecutive months is generally exempt.
Washington D.C.
Washington D.C. implemented its individual mandate effective January 1, 2019. Residents must maintain qualifying health coverage or pay a penalty assessed through their D.C. income tax return. The penalty is calculated using either a per-person flat fee or a percentage of income, whichever is greater.
Vermont
Vermont has an individual mandate written into state law but does not currently impose a monetary penalty for non-compliance. The state uses coverage data collected through tax filings to identify uninsured residents and connect them with coverage options.
Is Health Insurance Required in California and Texas?
Two of the most frequently searched questions are whether coverage is mandatory in California and Texas. The answers sit at opposite ends of the spectrum.
Is health insurance required in California? Yes, with enforceable penalties. The California Franchise Tax Board assesses a minimum fine of $950 per uninsured adult for the 2025 tax year. The penalty is calculated monthly, so a resident without coverage for six months owes half the annual amount.
Is health insurance required in Texas? No. Texas does not impose any state-level health insurance mandate or penalty. Residents can go without coverage without facing any state or federal tax consequence.
The table below summarizes the mandate status and penalty structure across all six jurisdictions:
| Jurisdiction | Mandate in Effect Since | Penalty Calculation Basis |
|---|---|---|
| California | Jan 1, 2020 | Greater of $950/adult or 2.5% of income above filing threshold |
| Massachusetts | 2006 | Sliding scale; capped at 50% of lowest-cost plan |
| New Jersey | Jan 1, 2019 | Income and family size; capped at statewide bronze plan average |
| Rhode Island | Jan 1, 2020 | Greater of 2.5% of income or flat dollar; capped at bronze plan average |
| Washington D.C. | Jan 1, 2019 | Greater of flat fee per person or 2.5% of income above filing threshold |
| Vermont | On record | No monetary fine |
Sources: IRS, CA Franchise Tax Board, Mass.gov TIR 26-1, NJ Division of Taxation, RI Division of Taxation, healthinsurance.org.
If you need help understanding how these rules apply to a specific household situation, Momentary Lab's AI healthcare navigator can walk through your options based on your state and income.
Who Is Exempt from State Mandates?
Every state with an active individual mandate also offers exemption categories. Most people who qualify for an exemption face no penalty, even if they are uninsured for part or all of the year.
Common exemption categories recognized across mandate jurisdictions include:
Affordability hardship. Coverage is considered unaffordable if the lowest-cost qualifying plan available exceeds a set percentage of household income. In California, for the 2026 tax year, the affordability threshold is 8.05% of income for individual coverage, per Covered California.
Short coverage gap. A gap of fewer than three consecutive months generally does not trigger a penalty. Per the IRS, this exemption recognizes that job transitions and life changes can cause brief lapses in coverage. The Rhode Island Division of Taxation confirms that three or more consecutive uninsured months are required to trigger the penalty.
Low income. Residents whose income falls below the minimum threshold required to file a state tax return are generally exempt. In Massachusetts, per TIR 26-1, individuals at or below 150% of the federal poverty level owe no penalty.
Religious objection or health sharing ministry membership. Documented membership in a recognized religious sect or qualifying health care sharing ministry qualifies for exemptions in most mandate states, per Covered California.
Other hardship. Circumstances such as homelessness, domestic violence, natural disaster, or the passing of a close family member may qualify under hardship exemption provisions.
Exemptions are typically claimed on the state tax return using the applicable state form. A tax professional or insurance navigator can assist in identifying the right category and documentation required.
The Employer Mandate: What Large Employers Are Required to Offer
The individual mandate affects residents. A separate ACA provision, the employer mandate, affects large businesses nationwide, regardless of which state they operate in.
Per the IRS Employer Shared Responsibility provisions, employers classified as Applicable Large Employers (ALEs), meaning those that averaged 50 or more full-time or full-time equivalent employees during the prior calendar year, must offer affordable, minimum-value health coverage to at least 95% of their full-time workforce and their dependents up to age 26. Failing to do so, when at least one full-time employee receives a marketplace premium tax credit, triggers a shared responsibility payment to the IRS.
This means employees who work for companies with 50 or more staff have a legal right to be offered qualifying health coverage. If the offer is made and an employee chooses to decline it, the employer has fulfilled its obligation.
Small businesses with fewer than 50 full-time equivalent employees are not subject to the employer mandate.
What Being Uninsured Actually Costs
The absence of a legal penalty does not remove the financial considerations that come with going uninsured. In the 44 states with no mandate, any medical costs are paid directly out of pocket.
According to CMS, 24.2 million consumers selected ACA Marketplace coverage for 2025, an all-time enrollment high. A significant factor in that growth is the availability of premium tax credits, with four out of five HealthCare.gov consumers qualifying for plans at $10 or less per month after financial assistance.
For people without subsidized coverage, routine and unexpected medical services are billed at standard uninsured rates. Preventive services, such as annual checkups, screenings, and vaccinations, are covered at no cost-sharing under ACA-compliant plans but become billed services for uninsured patients. A doctor can advise on individual health circumstances and which preventive care services are most relevant to a given situation.
If you are currently uninsured and trying to understand your options, finding a doctor near you through Momentary Lab can connect you with a provider who may also be able to refer you to local coverage enrollment resources.
Options If You Are Currently Uninsured
Being uninsured today does not mean affordable coverage is unavailable. Several pathways exist for most income levels.
ACA Marketplace plans. The federal Health Insurance Marketplace at HealthCare.gov offers plans across four metal tiers: Bronze, Silver, Gold, and Platinum. Premium tax credits are available based on household income and size. Annual open enrollment runs from November 1 through January 15 in most states.
Special Enrollment Periods (SEPs). A qualifying life event, such as losing job-based coverage, getting married, having a child, or moving to a new state, opens a 60-day special enrollment window outside of regular open enrollment.
Medicaid. Medicaid covers individuals and families with incomes up to 138% of the federal poverty level in states that have expanded the program. Enrollment stays open year-round with no deadline.
COBRA continuation. Employees who lose coverage from an employer with 20 or more employees may elect COBRA within 60 days to continue the same plan. The enrollee pays the full premium plus a 2% administrative fee, while coverage, providers, and network remain unchanged.
Short-term health plans. These plans do not qualify as minimum essential coverage and will not satisfy state individual mandate requirements. They are banned in some states, including California. A doctor can advise on what short-term coverage does and does not include before a decision is made.
For guidance on which pathway applies based on income, state, and household size, Momentary Lab's AI healthcare navigator can help compare options without requiring an appointment.
Frequently Asked Questions
Is it illegal to have no health insurance in the US?
No. Going without health insurance carries no criminal penalty at the federal level. The IRS confirmed that the shared responsibility payment was reduced to $0 starting in tax year 2019 under the Tax Cuts and Jobs Act. The legal text of the ACA's coverage requirement remains, but no enforcement mechanism applies. Five states, California, Massachusetts, New Jersey, and Rhode Island, plus Washington D.C., impose their own state tax penalties for being uninsured. Vermont has a mandate but no monetary fine. All other 44 states have no coverage requirement.
Is migraine covered under health insurance?
Yes, in most cases. ACA-compliant health insurance plans are required to cover the diagnosis and treatment of medical conditions, which includes migraines. Coverage typically extends to physician visits, specialist referrals to neurologists, prescription medications, and diagnostic imaging such as MRI when clinically indicated. The specific cost-sharing involved, including deductibles, copays, or whether a particular medication appears on a plan's formulary, varies by plan. A doctor can advise on the individual treatment needs for migraines and help clarify what a specific plan covers.
Can I get life insurance with lupus?
Obtaining life insurance with a lupus diagnosis is possible in most cases. Insurers evaluate applications for systemic lupus erythematosus (SLE) by reviewing disease severity, time since diagnosis, current medications, and whether there is organ system involvement (meaning lupus affecting the kidneys, heart, lungs, or nervous system). Applicants with well-managed lupus and no major complications may qualify for standard or preferred-risk rates with certain carriers. Others may be placed in higher-risk underwriting categories at elevated premium rates. Options to explore include term life insurance, guaranteed-issue whole life insurance, and group life insurance through an employer, which typically does not require medical underwriting. A doctor can assist with compiling medical documentation that may support an application. A licensed insurance broker experienced in high-risk underwriting can identify which carriers are more likely to offer favorable terms.
Does health insurance cover cesarean?
Yes. The ACA designates maternity and newborn care as one of the ten essential health benefits that all non-grandfathered, ACA-compliant plans must cover. This includes both vaginal and cesarean deliveries, whether planned in advance or performed on an unplanned basis during labor. Cost-sharing provisions, such as a deductible, copay, or coinsurance, still apply depending on the plan's structure. Grandfathered plans, meaning those that existed before the ACA's enactment and have not undergone significant changes, may operate under different rules. Reviewing a plan's Summary of Benefits and Coverage document will confirm the specific cost-sharing that applies. A doctor can advise on individual birth circumstances and what clinical factors may influence how labor and delivery are managed.
