The penalty in each state
| Place | Tax year | Flat amount per adult | Per child | Income-based amount | Cap |
|---|---|---|---|---|---|
| California | 2025 | $950 | $475 (family flat amount up to $2,850) | 2.5% of household income above the state filing threshold | State average Bronze premium: $4,524 per person a year, up to $22,620 for 5 or more |
| New Jersey | 2025 | $695 | $347.50 (family flat amount up to $2,085) | 2.5% of household income above the filing threshold ($10,000 single, $20,000 joint) | Statewide average Bronze premium: $4,908 per person a year, up to $24,540 for 5 or more |
| Massachusetts | 2026 | $312 to $2,532 a year, by income ($26 to $211 a month) | None (adults only) | No penalty at or below 150% of the poverty level | Half the lowest Health Connector premium the person could have had |
| Rhode Island | 2025 | $695 | $347.50 (family flat amount up to $2,085) | 2.5% of modified adjusted gross income above the filing threshold | State average Bronze premium: $4,284 per person a year, up to $21,420 for 5 or more |
| Washington, DC | 2025 | $795 | $397.50 (family flat amount up to $2,385) | 2.5% of federal adjusted gross income above the DC filing threshold | DC average Bronze premium: $4,494 for one person, up to $22,468 for 5 or more |
| Vermont | Any | No penalty | No penalty | None | You report coverage on the state return |
Why 2025 numbers? California, New Jersey, Rhode Island and DC had not posted tax year 2026 worksheets on the pages we checked (New Jersey offers a 2026 estimator). Massachusetts already published its 2026 schedule. The penalty is figured per month, so a partial year without coverage costs less.
Example: one adult with $70,000 income in two states
Say a single adult under 65 with no dependents earned $70,000 and had no coverage and no exemption for all of 2025. This is an illustration, not tax advice; each state defines income its own way.
- California, flat amount: $950 for one adult.
- California, income amount: the 2025 gross income filing threshold for a single filer under 65 with no dependents is $22,941. $70,000 minus $22,941 is $47,059. 2.5% of that is about $1,176.
- California result: $1,176 is higher than $950 and under the $4,524 cap, so the penalty is about $1,176.
- New Jersey, flat amount: $695 for one adult.
- New Jersey, income amount: the filing threshold for a single filer is $10,000. $70,000 minus $10,000 is $60,000. 2.5% of that is $1,500.
- New Jersey result: $1,500 is higher than $695 and under the $4,908 Bronze cap, so the penalty is $1,500.
For comparison, in Massachusetts in 2026 a single person earning $70,000 is above 400% of the poverty level ($62,600 for one person), so a full year uninsured would cost $211 a month, or $2,532.
Common exemptions
Each state has its own list and its own form, but most include these:
- Income below the state's filing threshold. In New Jersey, people who don't have to file a state return are automatically exempt.
- A short gap in coverage. Usually less than three consecutive months. Massachusetts allows a gap of 63 days or less, which its Health Connector reads as three calendar months.
- Coverage was unaffordable. For tax year 2025, California and Rhode Island used 7.28% of household income. New Jersey uses 8.05% for its Marketplace and job-based affordability exemptions.
- Hardship, religious conscience or a health care sharing ministry, membership in a federally recognized tribe, and incarceration.
- Living outside the state for part of the year. Part-year residents count only the months they lived there.
To claim them: California uses Form FTB 3853 (some hardship exemptions go through Covered California), New Jersey uses Schedule NJ-HCC, Rhode Island uses Form IND-HEALTH, DC uses Schedule HSR, and Massachusetts uses Schedule HC. State details: California, New Jersey, Massachusetts, Rhode Island and Washington, DC.
This is general information, not tax advice. Use your state's own worksheet or estimator, or ask a tax advisor about your situation.
What counts as coverage
These states generally accept minimum essential coverage: a job-based plan, a Marketplace plan, an individual plan bought directly from an insurer, Medicare Part A or Part C, and most Medicaid. Massachusetts is stricter: plans must meet its minimum creditable coverage standards.
Health care sharing ministries aren't insurance; California and other states handle them through an exemption instead. A care membership doesn't count either. Gabriel membership is not health insurance and is not minimum essential coverage, so it won't satisfy a state mandate. If you're unsure about a plan, check your state's list of qualifying coverage. See ACA-compliant health insurance.
Missed Open Enrollment? Losing other coverage, moving or another qualifying life event can open a special enrollment period.
Ask Gabriel with your numbers
Gabriel can work through the same penalty math with your own state, household and income, free. Ask Gabriel free.
If you'd rather have coverage, Gabriel can quote Marketplace plans for your ZIP code and household, show the price after any tax credit, and open your own application with a licensed agent in most states. You choose the plan and finish the application.
Gabriel is not an insurer. Health insurance quotes and enrollment are handled by Gabriel Labs, Gabriel's separately licensed insurance agency.
Common questions
Is there still a federal penalty for not having health insurance?
No. HealthCare.gov says the fee for not having health insurance no longer applies; it covered plan years 2018 and earlier. Only a few states charge their own penalty.
What is the penalty for no health insurance in California?
For tax year 2025, the higher of $950 per adult and $475 per child, or 2.5% of household income above the state filing threshold, capped at the state average Bronze premium ($4,524 per person). The Franchise Tax Board's Penalty Estimator gives your number.
How do I avoid the California health insurance penalty?
Have qualifying coverage for every month, or qualify for an exemption, such as income below the filing threshold, a gap of three months or less, or coverage that cost more than 7.28% of household income in 2025. Claim exemptions on Form FTB 3853.
Which states have an individual mandate?
California, New Jersey, Massachusetts, Rhode Island and Washington, DC require coverage and charge a penalty. Vermont requires coverage but has no penalty.
Do children count toward the penalty?
In California, New Jersey, Rhode Island and DC, a child's flat amount is half an adult's. Massachusetts penalizes adults only.
Does a care membership like Gabriel avoid the penalty?
No. Gabriel membership is not health insurance and is not minimum essential coverage. Check your state's list of qualifying coverage.
Sources
- FTB 3853 Instructions 2025: Health Coverage Exemptions and Individual Shared Responsibility Penalty California Franchise Tax Board
- 2025 Form NJ-1040 instructions (Worksheet L) New Jersey Division of Taxation
- TIR 26-1: Individual Mandate Penalties for Tax Year 2026 Massachusetts Department of Revenue
- 2025 Instructions for Form IND-HEALTH and Shared Responsibility Worksheet Rhode Island Division of Taxation
- 2025 Schedule HSR: DC Health Care Shared Responsibility DC Office of Tax and Revenue
- 32 V.S.A. Chapter 244: Health Insurance Coverage Requirement Vermont General Assembly
- Fee (glossary) HealthCare.gov
- Claim Exemptions New Jersey Division of Taxation
This guide is general information, not medical advice. It does not replace a visit with a licensed clinician. Gabriel membership is not health insurance.