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.
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?
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?
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?
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 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.