What if I don't have health coverage?



If you don't have health coverage in 2014, you may have to pay a fee. You also have to pay for all of your health care.

The fee is sometimes called the "penalty," "fine," "individual responsibility payment," or "individual mandate."

Important. Marketplace Open Enrollment ended March 31. You can now buy a Marketplace health plan only if you qualify for a special enrollment period. You can apply for Medicaid and CHIP any time.

Learn about special enrollment periods and other coverage options after Open Enrollment. Open Enrollment for 2015 coverage starts November 15, 2014.

The fee in 2014 and beyond

The penalty in 2014 is calculated one of 2 ways. If you or your dependents don’t have insurance that qualifies as minimum essential coverage you'll pay whichever of these amounts is higher:

  • 1% of your yearly household income. (Only the amount of income above the tax filing threshold, $10,150 for an individual, is used to calculate the penalty.) The maximum penalty is the national average premium for a bronze plan.

  • $95 per person for the year ($47.50 per child under 18). The maximum penalty per family using this method is $285.

The way the penalty is calculated, a single adult with household income below $19,650 would pay the $95 flat rate. A single adult with household income above $19,650 would pay an amount based on the 1% rate. (If income is below $10,150, no penalty is owed.)

The penalty increases every year. In 2015 it’s 2% of income or $325 per person. In 2016 and later years it’s 2.5% of income or $695 per person. After that it's adjusted for inflation.

If you’re uninsured for just part of the year, 1/12 of the yearly penalty applies to each month you’re uninsured. If you’re uninsured for less than 3 months, you don’t have to make a payment.

You’ll pay the fee on your 2014 federal income tax return. Most people will file this return in 2015.

Learn more about the individual shared responsibility payment from the Internal Revenue Service.

When the uninsured need care

When someone without health coverage gets urgent — often expensive — medical care but doesn't pay the bill, everyone else ends up paying the price.

That's why the health care law requires all people who can afford it to take responsibility for their own health insurance by getting coverage or paying a fee.

If you pay the fee, you're not covered

It's important to remember that even if you pay the penalty you still don't have any health insurance coverage. You are still responsible for 100% of the cost of your medical care.

Minimum essential coverage

To avoid the penalty you need insurance that qualifies as minimum essential coverage. If you're covered by any of the following, you're considered covered and don't have to pay a penalty:

  • Any Marketplace plan, or any individual insurance plan you already have
  • Any employer plan (including COBRA), with or without “grandfathered” status. This includes retiree plans
  • Medicare
  • Medicaid
  • The Children's Health Insurance Program (CHIP)
  • TRICARE (for current service members and military retirees, their families, and survivors)
  • Veterans health care programs (including the Veterans Health Care Program, VA Civilian Health and Medical Program (CHAMPVA), and Spina Bifida Health Care Benefits Program)
  • Peace Corps Volunteer plans
  • Self-funded health coverage offered to students by universities for plan or policy years that begin on or before Dec. 31, 2014

Other plans may also qualify. Ask your health coverage provider.

Health plans that don't qualify as coverage

Health plans that don't meet minimum essential coverage don't qualify as coverage in 2014. If you have only these types of coverage, you may have to pay the fee. Examples include:

  • Coverage only for vision care or dental care
  • Workers' compensation
  • Coverage only for a specific disease or condition
  • Plans that offer only discounts on medical services

Exemptions from the fee

Some people with limited incomes and other situations can get exemptions from the fee. Learn about exemptions from paying the fee.