State-Level Health Insurance Mandates: Where Penalties Still Apply After the Federal Repeal

As of 2024, five states and the District of Columbia maintain their own mandates, requiring residents to hold "minimum essential coverage" or face potential tax penalties.

States With Active Health Insurance Mandates

Vermont also mandates coverage, though the state does not currently impose a financial penalty for non-compliance.

• California: Residents must maintain coverage or face a penalty of $900 per adult and $450 per dependent child under 18.
• Massachusetts: The state enforces a penalty ranging from $288 to $2,100 per person, depending on income and household size.
• New Jersey: Penalties for lacking coverage are calculated based on income and family size, with amounts ranging from $695 to $4,284.
• Rhode Island: The penalty is the greater of $695 per adult ($347.50 per child) or 2.5% of annual household income.
• Washington, D.C.: Similar to the federal mandate’s former structure, the penalty is the greater of $695 per adult ($347.50 per child) or 2.5% of annual household income.

Understanding the Federal Shift

The federal individual mandate was a cornerstone of the Affordable Care Act (ACA), requiring most Americans to maintain basic health insurance or pay a fee to the Internal Revenue Service (IRS). This federal requirement effectively ended on January 1, 2019, when the tax penalty was reduced to zero dollars. While the legal obligation remains on the books, the lack of a federal tax consequence means the IRS no longer penalizes taxpayers for failing to carry insurance at the national level.

Available Assistance and Coverage Options

For individuals struggling to afford premiums, several government programs exist to provide subsidized or low-cost care. Eligibility for these programs typically depends on income, age, employment status, and household size.

Key resources for securing coverage include:

• The Health Insurance Marketplace: Established under the ACA, this platform allows individuals to compare private plans and access federal subsidies based on income.
• Medicaid: A joint federal and state program that provides health coverage to eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities.
• CHIP (Children’s Health Insurance Program): Provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid but cannot afford private insurance.
• Medicare: A federal health insurance program primarily for people aged 65 or older, as well as younger people with certain disabilities.
• COBRA (Consolidated Omnibus Budget Reconciliation Act): Allows workers and their families who lose their health benefits to choose to continue group health benefits provided by their group health plan for limited periods under certain circumstances.

Residents in states with mandates should review their local tax filings and state health department guidelines to ensure compliance. Those seeking coverage are encouraged to visit HealthCare.gov to determine their eligibility for marketplace plans or state-specific programs.