Is Health Insurance Mandatory?

Health insurance is not mandatory at the federal level. Some states may impose a tax penalty if you do not have health insurance, but the federal government no longer does that. This changed at the start of 2019. Of course, while no health insurance can save you money now, it could cost you a lot if you get sick or hurt in the future. Here’s what you need to know about health insurance and mandates over time.

Affordable Care Act’s Coverage Mandate

The Affordable Care Act (ACA), signed into law in 2010, was designed to make health insurance coverage more affordable for Americans through the creation of tax subsidies while also opening up Medicaid eligibility to more low-income individuals and families.

The ACA effectively made having health insurance mandatory—not having it meant you would incur a tax penalty. But what about now? What is the penalty for not having health insurance?

Well, there is none now. As of Jan. 1, 2019, there is no mandate for health insurance at the federal level.

Before 2019, under the ACA, also called Obamacare, U.S. adults who were not otherwise eligible for an exemption were required to have health insurance coverage for themselves and their families. Failure to have minimum health insurance triggered a tax penalty. At the same time, the ACA allowed for the creation of a premium tax credit to help Americans offset some of the cost of getting health insurance through the Health Insurance Marketplace.

This rule changed in 2019 when the tax penalty mandate for health insurance was eliminated. While the ACA technically still exists, U.S. adults who choose not to maintain health insurance for themselves or their family members in 2019 and beyond won’t be penalized at tax time.

State-Imposed Rules on Health Insurance Coverage

While the federal government no longer requires you to have health insurance, a handful of states have mandates on the books regarding coverage or are trying to pass laws to make health insurance mandatory.

The states that require coverage include:

• California
• Massachusetts
• New Jersey
• Rhode Island
• Vermont

Washington, D.C., also requires residents to purchase health insurance. Other states—including Connecticut, Hawaii, Maryland, Minnesota, and Washington state—have also attempted to pass legislation that would make health insurance mandatory for their residents.

In states where health insurance is mandatory, the rules for getting and maintaining coverage are similar to those under the ACA, with coverage available through state-run health insurance marketplaces.

No Mandatory Health Insurance: Advantages

The primary upside to health insurance no longer being mandatory at the federal level is the money you don’t have to spend on premiums that remains in your pocket. That could be helpful if you’re trying to pay off student loans or save money toward a down payment on a home.

Of course, if your employer offers some type of health insurance coverage as part of your benefits package, you may be able to get affordable coverage without having to shop around for it.

No Mandatory Health Insurance: Disadvantages

It takes a very savvy health care consumer to score discounts from providers, not all of whom will necessarily go along with such requests. Normally, insurance companies, not individuals, are the ones negotiating with hospitals and doctors to lower prices for large member groups.

However, the main drawback when health insurance isn’t mandatory is the risk that you assume when choosing the self-pay route. The downside of going without health insurance could be substantial if you end up needing expensive medical care and you don’t have the money to pay for it from savings or your monthly income.

Even a minor health issue could result in a financial setback. According to UnitedHealth Group, the average cost of an emergency room visit to treat issues that could be handled at an urgent care or primary care facility was just over $2,000 in 2019.

That cost is 10 times higher compared to seeing an urgent care doctor and 12 times higher than primary care, but people who don’t have health insurance may assume the ER is their only option if they get sick or hurt. Additionally, illness and medical bills are known contributors to bankruptcy.

Options for Health Insurance Coverage

Before going without health insurance, Nicholson reviewed all of her options, which included being added to her husband’s plan and enrolling in a healthcare cost-sharing program. These are also things that you might consider if you’re without health insurance or thinking about canceling your plan since coverage is no longer mandatory.

You may consider short-term health insurance or catastrophic care policies, but these have their limitations in terms of what’s covered and who’s eligible. Applying for Medicaid may also be an option, but whether you qualify is dependent on your income and family size. Each state has different guidelines with regard to the income and asset thresholds allowed for eligibility for Medicaid coverage.

The Bottom Line

Not being required by federal law to have health insurance coverage doesn’t mean you don’t need it. If you don’t have health insurance, take time to research coverage options to determine which is the best fit for your healthcare needs and budget.