Six States Require Health Insur­ance For 2020

The fed­eral tax penalty for going with­out health insur­ance ended in 2019, but a hand­ful of states have enacted their own laws to replace it. The legal term for this type of health insur­ance require­ment is an “indi­vid­ual man­date.”

For 2020, state indi­vid­ual man­dates exist in Cal­i­for­nia, the Dis­trict of Colum­bia, Mass­a­chu­setts, New Jer­sey, Rhode Island, and Ver­mont. For the most part, these state laws mir­ror the for­mer require­ments of the Afford­able Care Act. In all but one (Ver­mont), you may face a state tax penalty if you are unin­sured in 2020.

States With Indi­vid­ual Man­dates for Health Insur­ance

Here’s a sum­mary of each state’s indi­vid­ual man­date rules.

Cal­i­for­nia

Begin­ning Jan­u­ary 1, 2020, Cal­i­for­nia law requires you to have health insur­ance. A com­pli­cated for­mula deter­mines the penalty you may face, but it’s sim­i­lar to the for­mer ACA penalty. That means $695 per unin­sured adult ($347.50 per child) up to a max­i­mum of $2085 or 2.5% of your house­hold income, whichever is greater. For the income-​based cal­cu­la­tion, the max­i­mum penalty is the aver­age annual cost for a bronze plan from Cov­ered Cal­i­for­nia. To learn more, see our sum­mary of cov­er­age require­ments and exemp­tion rules for Cal­i­for­nia.

Dis­trict of Colum­bia

The D.C. health insur­ance man­date took effect on Jan­u­ary 1, 2019. Like most of the other state indi­vid­ual man­dates, the penalty is $695 for each unin­sured adult (half that amount for a child) up to a max­i­mum of $2085 or 2.5% of house­hold income, whichever is greater. For the income per­cent­age cal­cu­la­tion, the max­i­mum penalty is the aver­age annual cost of a bronze plan pur­chased at D.C. Health Link. To find out what counts as cov­er­age and whether you’re exempt, see Do I Have to Get Health Insur­ance in the Dis­trict of Colum­bia?

Mass­a­chu­setts

The Mass­a­chu­setts health insur­ance require­ment does not track the Afford­able Care Act’s struc­ture. That’s because the state had an indi­vid­ual man­date for sev­eral years before the ACA passed. In fact, the Mass­a­chu­setts man­date inspired the ACA’s health insur­ance require­ment. In Mass­a­chu­setts, the penalty may be as much as 50% of what you would have paid to get cov­ered by a plan sold at Mass­a­chu­setts Health Con­nec­tor. For a sum­mary of min­i­mum cov­er­age require­ments and exemp­tion rules, see Do I Have to Get Health Insur­ance in Mass­a­chu­setts?

New Jer­sey

The New Jer­sey indi­vid­ual man­date took effect on Jan­u­ary 1, 2019, and it’s based on the for­mer ACA penalty. Those who are unin­sured for all of 2020 will have to pay $695 per adult/$347.50 per child (up to a house­hold max­i­mum of $2,085) or 2.5% of house­hold income, whichever is greater. The max­i­mum penalty for the income-​based cal­cu­la­tion is the aver­age yearly pre­mium of a bronze plans in New Jer­sey. To learn what qual­i­fies as min­i­mum cov­er­age and whether you may be exempt, see Do I Have to Get Health Insur­ance in New Jer­sey?

Rhode Island

Begin­ning Jan­u­ary 1, 2020, Rhode Island law requires you to have health insur­ance unless you qual­ify for an exemp­tion. It too bases its penalty on the ACA struc­ture: $695 per unin­sured adult ($347.50 per child) up to a max­i­mum of $2085 or 2.5% of your house­hold income, whichever is greater. For the income per­cent­age cal­cu­la­tion, the penalty is capped at the aver­age annual pre­mium cost for a bronze-​level plan pur­chased at Health Source RI. Here’s a sum­mary of cov­er­age require­ments. The state has­n’t yet pub­lished exemp­tion guide­lines.

Ver­mont

Ver­mont law requires you to have health insur­ance begin­ning Jan­u­ary 1, 2020. But state law­mak­ers haven’t been able to agree on what the penalty should be. For now, it looks like you’ll have to report whether you have 2020 health cov­er­age when you file your Ver­mont tax return, but you won’t have to pay any­thing for being unin­sured.

For More Infor­ma­tion

Open enroll­ment for 2020 health plans is com­ing soon. In most states, it starts Novem­ber 1 and runs through Decem­ber 15. (In Cal­i­for­nia, open enroll­ment starts today, Octo­ber 15!) For infor­ma­tion about find­ing afford­able health insur­ance where you live, visit Legal Consumer’s Oba­macare learn­ing cen­ter.