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Go Without Insurance?

The health law requires most Americans to have or obtain health coverage, pay a penalty, or receive an exemption.

Health coverage can include:

  • Job-based coverage;
  • Individual or family coverage obtained through DC Health Link, Medicare, Medicaid, TRICARE, veterans' health coverage, certain student health insurance plans;
  • Some other types of coverage recognized by the Secretary of the U.S. Department of Health and Human Services as minimum essential coverage.

Exemptions

The health law exempts certain people from this requirement. Individuals or households with incomes below the threshold for filing a federal tax return are automatically exempted. Others will have to file for the exemption on their taxes or through the federal government.

They include:

  • Those who would have to spend more than 8 percent of their household income to buy insurance;
  • Those who are incarcerated;
  • People who are not lawfully present (i.e., not a U.S. citizen, a U.S. national, or an alien lawfully present in the U.S.).
  • There are many other exemptions that may apply to your or your family including hardship exemptions.

For more information please visit the IRS website to review Questions and Answers on the Individual Shared Responsibility Provision.

Consumers who are not exempted and go without health coverage for longer than 2 full consecutive months will have to pay a penalty on their tax returns. The payment is based on the number of months an individual or family goes without health coverage.

Penalties & Fees

For someone who goes a full year without coverage, the payment is:

2015

$325 for each adult and $162.50 for each child, up to $975 per family

  or  

2% of family income that is over the tax filing threshold, whichever is greater

2016 & 2017

$695 for each adult and $347.50 for each child, up to $2,085 per family

  or  

2.5% of family income that is over the tax filing threshold, whichever is greater

Here's an example for a family of 4 with a household income of $98,000

$695
$695
$347.50
$347.50

Total: $2,085

2.5% of $98,000

Total: $2,450

The penalty will never be higher than the national average premium for a bronze level health plan (the least expensive type of comprehensive plan).

To estimate what your penalty might be if you go without coverage for part or all of the year, use The Taxpayer Advocate Service’s Individual Shared Responsibility Provision Payment Estimator. If you have questions about being exempt from the penalty, call the HHS consumer call center at 1-800-318-2596. Hearing impaired callers using TTY technology can call 1-855-889-4325 for assistance.