If you have been wondering whether skipping health coverage this year will cost you money at tax time, the answer depends entirely on where you live. There is no federal penalty for not having health insurance in 2025. That was eliminated back in 2019. But five states and Washington, D.C. still charge residents a fine, and those amounts have quietly increased. Whether you are between jobs, weighing the cost of premiums, or simply trying to understand what is the fee for not having health insurance in your state, this guide breaks it all down clearly.
Quick Summary: Health Insurance Penalty at a Glance
| Topic | Key Facts |
|---|---|
| Federal penalty (2025) | $0, eliminated by the Tax Cuts & Jobs Act effective January 1, 2019 |
| States with active penalties | California, Massachusetts, New Jersey, Rhode Island, Washington D.C. |
| State with a mandate but no fine | Vermont (requires reporting, no dollar penalty) |
| All other states | No penalty, no mandate |
| Who enforces state penalties | State tax authorities, not the IRS |
| When penalties are assessed | When you file your state income tax return |
| Ways to avoid the fine | Qualifying exemptions: income, hardship, religious beliefs, short coverage gaps |
Is There a Federal Penalty for Not Having Health Insurance in 2025?
No. There is no federal penalty for being uninsured in 2025.
The Tax Cuts and Jobs Act of 2017 reduced the federal individual mandate penalty to zero, effective January 1, 2019. For tax years 2019 through the present, no one pays a federal fine for going without coverage. The federal Form 1040 no longer asks about your health insurance status, so there is nothing to report to the IRS on this point.
The individual mandate itself technically remains in federal law, but with a $0 penalty attached, it has no practical enforcement.
Quick answer: Can you get penalized for not having health insurance at the federal level? No, not since 2019.
Still unsure how this applies to your situation? Momentary Lab's AI healthcare navigator can help you sort through your coverage options quickly.
Which States Still Fine You for Not Having Health Insurance?
Five states and Washington, D.C. enforce their own individual mandates with real financial penalties. Vermont is a unique case: the state law requires residents to carry coverage and asks about it on your tax return, but imposes no dollar fine for non-compliance.
Here is the current landscape, according to healthinsurance.org:
- California — Mandate with penalty (since 2020)
- Massachusetts — Mandate with penalty (since 2006, predates the ACA)
- New Jersey — Mandate with penalty (since 2019)
- Rhode Island — Mandate with penalty (since 2020)
- Washington, D.C. — Mandate with penalty (since 2019)
- Vermont — Mandate on the books, no monetary penalty
If you live in any of the 44 remaining states, including Texas, Florida, New York, Illinois, and Pennsylvania, there is no penalty for being uninsured in 2025. The absence of a mandate in those states does not mean going uninsured is risk-free, but no tax fine will appear on your return.
Will I get penalized for not having health insurance if I live in Ohio? No. Ohio has no state mandate. You will owe nothing extra on your state or federal return for being uninsured.
How Much Is the Fine for Not Having Health Insurance? State-by-State Breakdown
Every penalty state uses the same basic formula: you owe either a flat dollar amount per person or a percentage of your household income, whichever is higher. Each state also sets a maximum cap, usually tied to the average cost of a Bronze-tier health plan sold through its marketplace.
California
According to the California Franchise Tax Board, the 2025 penalty is:
- $950 per uninsured adult
- $475 per uninsured child (under 18)
- Or 2.5% of household income above the state filing threshold, whichever is higher
A married couple without coverage owes at least $1,900. According to IndexBox, a family of four could face a penalty of at least $2,850. The maximum is capped at the cost of a Bronze plan available through Covered California. The penalty is assessed via California Form 3853 when you file your state return.
Massachusetts
Massachusetts has the oldest mandate in the country, dating to 2006. The penalty structure is income-based and updated annually by the Massachusetts Health Connector.
- Residents with incomes at or below 150% of the Federal Poverty Level owe no penalty
- For incomes between 150% and 500% FPL, the monthly penalty equals half the lowest ConnectorCare premium available at that income level
- For incomes above 500% FPL, the monthly penalty equals half the lowest Bronze plan premium
- The total annual penalty cannot exceed 50% of the minimum monthly premium available to that individual
Residents report compliance on Schedule HC, filed with their state income tax return. Massachusetts also offers a grace period: lapses of up to 63 consecutive days, interpreted by the Health Connector as three calendar months, do not trigger a penalty.
New Jersey
New Jersey's Health Insurance Market Preservation Act mirrors the structure of the original ACA federal penalty:
- $695 per adult and $347.50 per child, or 2.5% of annual household income above the state filing threshold, whichever is higher
- The maximum is capped at the statewide average annual Bronze plan premium
- Higher-income households can face penalties exceeding $3,492 depending on income
Residents attach Schedule NJ-HCC to their state return.
Rhode Island
Rhode Island's mandate took effect in 2020. The penalty is:
- $695 per uninsured adult and $347.50 per uninsured child, or 2.5% of modified adjusted gross income above the threshold, whichever is higher
- Capped at the average annual cost of a Bronze plan sold through HealthSource RI
Rhode Island calculates the penalty monthly, so a partial year without coverage results in a prorated fine. A short gap of one or two consecutive months is fully exempt, per the Rhode Island Division of Taxation. Residents report via Form IND-HEALTH.
Washington, D.C.
D.C.'s mandate has been in place since 2019. According to IndexBox, the monthly penalty is:
- $795 per adult and $397.50 per child, or 2.5% of household income above the federal filing threshold, whichever is higher
- The family maximum is approximately $2,385 per month, capped at the average cost of a Bronze plan
Residents file via Schedule HSR with their D.C. income tax return.
State Penalty Comparison Table
| State | Per Adult | Per Child | Income Formula | Family of 4 Estimate |
|---|---|---|---|---|
| California | $950/year | $475/year | 2.5% of income above threshold | $2,850+ |
| Massachusetts | Income-based (varies) | N/A (adults only) | 50% of lowest available premium | Varies by income |
| New Jersey | $695/year | $347.50/year | 2.5% of household income | $3,492+ at higher incomes |
| Rhode Island | $695/year | $347.50/year | 2.5% of MAGI | Varies, prorated monthly |
| Washington D.C. | Up to $9,540/year | Up to $4,770/year | 2.5% of household income | Capped at Bronze plan cost |
| Vermont | $0 | $0 | No penalty enforced | $0 |
Exact amounts depend on income, household size, and available Bronze plan costs in each market. Use each state's official penalty estimator tool for a personalized figure.
What If You Were Only Uninsured for Part of the Year?
This is one of the most commonly asked questions in this area, and the answer varies by state.
At the federal level, there is no partial-year consideration because there is no penalty at all.
For state penalties, each mandate state calculates the fine on a monthly basis. If you had qualifying coverage for some months but not others, you generally owe a prorated penalty for only the uncovered months.
Short-gap exceptions by state:
- Massachusetts exempts lapses of up to 63 consecutive days (three calendar months) under TIR 25-1
- Rhode Island exempts gaps of one or two consecutive months
- California, New Jersey, and D.C. calculate month by month with no automatic short-gap waiver, though hardship exemptions may apply
If you changed jobs, moved states, or had a gap in employer coverage mid-year, you likely owe less than the full annual penalty, and you may qualify for an exemption entirely.
Exemptions: How to Avoid the Penalty Even in a Mandate State
Most people who owe a state penalty have options to reduce or eliminate it. Every mandate state offers exemptions, and many residents qualify without realizing it.
Income-Based Exemptions
If health insurance premiums would exceed a certain percentage of household income, the resident is generally exempt from the mandate. Each state sets its own affordability threshold. In Massachusetts, residents below 150% of the Federal Poverty Level owe nothing. California waives the penalty for residents whose income falls below the state filing threshold.
Hardship Exemptions
Life circumstances that make purchasing coverage genuinely difficult are recognized across all five mandate states. Common qualifying hardships include:
- Medical debt that significantly depleted household finances
- Eviction, foreclosure, or homelessness
- Domestic violence or death of a close family member
- Utility shutoff
- Incarceration
- Natural disaster
These exemptions are underused. If you faced a significant financial or personal hardship during the year, check your state's exemption application before assuming the full fine applies.
Religious Conscience Exemptions
Members of certain recognized religious groups that object to insurance on theological grounds may qualify for an exemption in California, New Jersey, Rhode Island, and D.C.
Short Coverage Gap Exemptions
Massachusetts and Rhode Island offer automatic exemptions for short coverage gaps. Other states may grant similar relief through their hardship exemption process when a gap was caused by a job change or other qualifying event.
If you are not sure what exemptions apply in your state, Momentary Lab's AI healthcare navigator can help clarify your options. You can also find a doctor or benefits advisor near you for more personalized guidance.
What Actually Happens When You Are Uninsured: The Real Financial Exposure
The state penalty is only one part of the picture, and for most uninsured people it is not the most expensive consequence of going without coverage.
When you do not have health insurance, every medical encounter is billed at the uninsured rate, which is typically the highest price a provider charges. Insurance companies negotiate lower rates on behalf of their members; uninsured individuals generally do not benefit from those discounts.
Some cost benchmarks sourced from federal data:
- The average cost of a treat-and-release emergency department visit was $750 in 2021, per the Agency for Healthcare Research and Quality (AHRQ) HCUP Statistical Brief #311. More complex ER visits requiring admission carry substantially higher costs.
- The average per-day hospital cost reached $3,132 in 2023, according to KFF analysis of American Hospital Association data. A standard three-day hospital stay can approach $30,000, per HealthCare.gov.
- According to KFF's Health Care Debt Survey, about 4 in 10 U.S. adults carry some form of healthcare debt, and those with debt are more likely to delay or skip recommended care.
The state penalty, which for most people ranges from roughly $700 to $2,000 per year, can seem manageable until an unexpected health event arises. That context matters when weighing whether coverage is worth the monthly premium.
Going without insurance also creates real gaps in managing ongoing conditions. People living with ischemic heart disease, for example, require consistent monitoring and medication access that becomes financially strained without coverage. The same applies to people managing macrovascular complications of diabetes, where gaps in care can accelerate disease progression.
Bottom line: Going uninsured trades a predictable monthly premium for unpredictable, often much larger, out-of-pocket expenses.
What to Do If You Cannot Afford Health Insurance
If cost is the reason you are uninsured, there are more options available than many people realize.
Medicaid
Medicaid provides free or very low-cost coverage to individuals and families with incomes up to 138% of the Federal Poverty Level in states that have expanded the program, per Healthcare.gov. As of 2025, 40 states and D.C. have expanded Medicaid. The 2025 Federal Poverty Level for a single person is $15,650, meaning 138% of that threshold is approximately $21,597 per year.
If your income falls below that level in an expansion state, you likely qualify for Medicaid at no monthly premium cost. Children are generally eligible at much higher income levels through CHIP, the Children's Health Insurance Program.
ACA Marketplace Subsidies
For those who earn too much for Medicaid but still find premiums difficult to manage, the ACA Marketplace offers premium tax credits that reduce monthly costs. According to healthinsurance.org, subsidies for 2026 coverage are available to individuals and families earning between 100% and 400% of the Federal Poverty Level.
Note that enhanced subsidies available through 2025 under the American Rescue Plan expired at the end of 2025. The income cap has returned to 400% FPL for 2026 coverage, and subsidies cover a smaller share of premiums than they did in recent years. If you were receiving enhanced subsidies, your costs may be higher this year.
Open enrollment for 2026 Marketplace plans ran November 1 through January 15, 2026, in most states. If you missed that window, you may still qualify for a Special Enrollment Period after a qualifying life event, such as job loss, marriage, the birth of a child, or a move to a new coverage area.
Short-Term Health Plans
Short-term plans are lower-cost options that can cover gaps between longer-term coverage. They do not satisfy ACA minimum essential coverage standards and will not protect you from a state mandate penalty in California, Massachusetts, New Jersey, Rhode Island, or D.C. For people in non-mandate states who need temporary coverage between jobs or while waiting for open enrollment, they can be a practical stopgap.
If you are unsure which path applies to your situation, finding a healthcare navigator near you is a practical first step.
Frequently Asked Questions
Is there a penalty for not having health insurance in 2025?
At the federal level, no. The federal individual mandate penalty was reduced to $0 starting in 2019 under the Tax Cuts and Jobs Act. Residents of California, Massachusetts, New Jersey, Rhode Island, and Washington D.C. may still face a state-level fine when filing their state income tax returns.
What is the tax penalty for not having health insurance in California?
California's 2025 penalty is $950 per uninsured adult and $475 per uninsured child, or 2.5% of household income above the state filing threshold, whichever amount is greater. A family of four with no coverage could owe $2,850 or more, per the California Franchise Tax Board. The maximum is capped at the cost of a Bronze-tier Marketplace plan.
How much is the fine for not having health insurance in Massachusetts?
The Massachusetts penalty is income-based and calculated monthly. Residents with incomes at or below 150% of the Federal Poverty Level owe nothing. Above that threshold, the monthly penalty equals half the lowest available ConnectorCare or Bronze plan premium, per Mass.gov TIR 25-1. Lapses of up to 63 consecutive days do not trigger a fine.
What if I don't have health insurance and can't afford it?
Several programs may help. Medicaid covers individuals with incomes up to 138% of the Federal Poverty Level in expansion states at no cost. ACA Marketplace plans offer premium tax credits for those earning between 100% and 400% of FPL. A Special Enrollment Period may allow enrollment outside of open enrollment if you recently lost coverage, changed jobs, or experienced another qualifying life event.
Do you get fined for not having health insurance if you only went without coverage for a few months?
State penalties are prorated monthly, so you generally owe only for the months you lacked qualifying coverage. Massachusetts and Rhode Island offer automatic short-gap exemptions for lapses of up to two or three consecutive months. Other states may grant similar relief through their hardship exemption process.
Is migraine covered under health insurance?
Most ACA-compliant health insurance plans cover migraine treatment, including specialist visits, prescription medications, and preventive therapies such as Botox injections when medically indicated. Coverage for newer migraine-specific medications, including CGRP inhibitors, may require prior authorization. Reviewing your plan's formulary or speaking with a benefits advisor can clarify what your specific plan covers. Find a provider near you to explore your options.
Does health insurance cover cesarean delivery?
Yes. All ACA-compliant health insurance plans are required to cover maternity and newborn care, which includes both vaginal and cesarean deliveries, per Healthcare.gov. Out-of-pocket costs, including deductibles, copayments, and coinsurance, depend on your specific plan and whether you use in-network providers. Medicaid also covers cesarean delivery for eligible individuals.
Does private health insurance cover hip replacement?
Most private health insurance plans cover hip replacement surgery when it is deemed medically necessary, subject to the plan's deductible, copay, and coinsurance requirements. Prior authorization is commonly required. Whether you use in-network or out-of-network providers significantly affects your total out-of-pocket cost. Find a doctor near you to understand your coverage before scheduling a procedure.
Is anemia covered under health insurance?
Yes. Anemia diagnosis and treatment, including blood tests, iron infusions, B12 injections, and specialist referrals, are covered by most ACA-compliant health insurance plans under preventive and outpatient care benefits. Specific treatment coverage depends on the underlying cause and whether the treatment aligns with standard-of-care guidelines. If you have questions about your plan's coverage, Momentary Lab's AI healthcare navigator can help you understand your benefits.
The Bottom Line
Whether or not you owe a penalty for going without health insurance in 2025 comes down to your state of residence. For the majority of Americans across 44 states, there is no fine. For residents of California, Massachusetts, New Jersey, Rhode Island, and Washington D.C., state-level penalties apply and are collected through tax returns.
Beyond the fine itself, the practical risk of going uninsured is exposure to healthcare costs that can far exceed any annual penalty amount. Chronic conditions including hypertension, hypothyroidism, and diabetes require consistent, ongoing care that becomes significantly harder to access without coverage. The encouraging reality is that options exist across nearly every income level, from Medicaid at no cost to subsidized Marketplace plans for moderate incomes.
If you are unsure what applies to your state or income level, Momentary Lab's AI healthcare navigator is a free starting point. You can also find a doctor or healthcare advisor near you for more hands-on support.
