At the federal level, the penalty for not having health insurance was eliminated in 2019. But 5 states still impose their own penalty. And the bigger risk isn't the penalty — it's the medical bills.
Federal Penalty (2026)
$0. The Tax Cuts and Jobs Act of 2017 reduced the federal individual mandate penalty to zero starting January 1, 2019. The mandate technically still exists in law, but there's no financial penalty for not having coverage at the federal level.
States with Their Own Penalty
| State | Penalty (2026) | Family Max |
|---|---|---|
| California | $900 per adult / $450 per child OR 2.5% of household income | Average bronze plan cost |
| Massachusetts | $25–$197/month based on income | Half of cheapest available premium |
| New Jersey | $695 per adult / $347.50 per child OR 2.5% of income | Average bronze plan cost |
| Rhode Island | $695 per adult / $347.50 per child OR 2.5% of income | Cap at average bronze premium |
| Washington DC | $700 per adult / $350 per child OR 2.5% of income | Average bronze plan cost |
| Vermont | Reporting required, no monetary penalty (yet) | N/A |
The REAL Cost of Going Uninsured
Forget the state penalty. Here's what really hurts:
- ER visit (no admission): $1,200–$3,000 average
- Broken arm: $2,500 (no surgery) — $16,000 (with surgery)
- Appendectomy: $33,000 average
- Childbirth (uncomplicated): $13,000 average
- Childbirth with C-section: $22,000+
- Heart attack hospitalization: $50,000–$100,000
- Cancer treatment (annual): $150,000+
Two-thirds of US bankruptcies cite medical bills as a cause. Most of those people thought "it won't happen to me" — until it did.
Exemptions from State Penalties
If you're in a penalty state, you may be exempt if:
- Your income is below the tax filing threshold
- The cheapest available plan would cost more than 8.05% of your household income
- You experienced a hardship (homelessness, eviction, domestic violence, bankruptcy)
- You're a member of a federally recognized tribe
- You had a coverage gap of less than 3 months
- You're incarcerated
- You're undocumented (different laws apply)
What If You Can't Afford Insurance?
You probably can. Most people who think they can't afford insurance haven't actually checked their subsidies. Common surprises:
- $0/month plans are available to ~80% of marketplace shoppers
- Medicaid expansion in 39 states + DC covers people up to 138% FPL ($20,120 single)
- Children's CHIP covers families up to 200%+ FPL
- Special hardship exemptions exist for those between Medicaid and subsidies
Don't assume you can't afford coverage. Our licensed agents will run your numbers in 60 seconds and show you exactly what you'd pay (often $0). Check your eligibility for free →