For individuals and employers, the penalties for not having health insurance matter more than you might think, and they've changed a lot. As of now, there is no federal penalty for individuals who do not have health insurance. That individual mandate penalty was zeroed out at the federal level starting in 2019, thanks to the Tax Cuts and Jobs Act of 2017. But things get trickier at the state level. Location matters.
The Federal Individual Mandate: From Penalty to $0
The ACA's individual mandate required most Americans to have qualifying health coverage or pay a penalty when filing federal taxes. This penalty, known as the "Shared Responsibility Payment," was calculated either as a percentage of household income or a flat fee per person, whichever was higher. The 2017 tax reform didn't repeal the mandate but set the penalty to $0, effectively eliminating it. So when you file your federal return now, you don't have to report coverage or claim an exemption to avoid a penalty.
State-Level Individual Mandates and Penalties
While the federal penalty is $0, several states and the District of Columbia have created their own individual healthcare mandates. These state laws encourage broad participation in the insurance risk pool, which helps keep premiums stable. If you live in one of these jurisdictions, you could face a state tax penalty for not having qualifying health coverage. The states with active individual mandates (as of 2026) include:
- California
- Massachusetts (which had a mandate pre-ACA)
- New Jersey
- Rhode Island
- District of Columbia
- Vermont (has a mandate but currently no associated penalty)
Each state has its own penalty structure, often modeled after the old federal calculations. Take California: for the 2025 tax year, the penalty is at least $950 per adult and $475 per dependent child, or 2.5% of household income above the filing threshold, whichever is higher. The state rules also carry over the old federal exemption categories. A coverage gap of less than three consecutive months, a qualifying hardship, or income below the state filing threshold can remove the penalty. Employers with workers in these states need to factor these rules into their benefits communication.
The Employer Mandate: Penalties Still in Full Force
It's critical to distinguish the individual mandate from the ACA's Employer Shared Responsibility provisions (often called the "employer mandate"). This mandate remains fully in effect, and the fines are real. It applies to applicable large employers (ALEs), generally those with 50 or more full-time equivalent employees. ALEs must offer affordable, minimum value health coverage to their full-time employees and their dependents, or they risk penalties if just one full-time employee receives a premium tax credit for buying coverage on a Health Insurance Marketplace.
The two primary employer penalties are:
- Penalty A (4980H(a)): Triggered if the employer does not offer coverage to at least 95% of its full-time employees and their dependents, and at least one employee gets a Marketplace subsidy. The annual penalty is $3,340 (for 2026) multiplied by all full-time employees (minus the first 30).
- Penalty B (4980H(b)): Triggered if the employer does offer coverage to at least 95% of full-time employees, but the coverage is deemed unaffordable or doesn't provide minimum value to an employee who then receives a Marketplace subsidy. The annual penalty is $5,010 (for 2026) per employee who receives a subsidy.
These penalties are indexed for inflation each year and represent a major compliance and financial risk for employers.
Subsidy Reset in 2026 Changes Employer Penalty Exposure
Both employer penalties depend on an employee actually receiving a premium tax credit for Marketplace coverage, and that trigger shrank in 2026. The enhanced premium tax credits first enacted in 2021 and extended through 2025 expired on December 31, 2025, restoring the subsidy cliff above 400% of the federal poverty level. KFF found that average Marketplace premium payments rose 58% from 2025 to 2026, and people just above the cliff, who were only 3% of 2025 sign-ups, accounted for 27% of the drop in sign-ups. The practical effect for employers is uneven. A workforce concentrated at lower wages still has many employees who qualify for subsidies and can trigger a penalty, while a workforce with more employees above 400% of the poverty level has fewer subsidy-eligible employees who can set the penalty in motion. Penalty A is less sensitive to this shift because it needs only one subsidized employee and then applies to all full-time employees; Penalty B rises and falls with the number of subsidized employees.
Strategic Considerations for Employers and Employees
The absence of a federal individual penalty doesn't make health coverage any less valuable. For employers, a solid benefits package helps attract talent, support wellness, and improve productivity. For employees, being uninsured carries huge financial risk from unexpected medical bills, plus the loss of potential employer contributions and pre-tax savings through cafeteria plans.
Innovative models like WellthCare™, which fuse health and wealth benefits, create a strong incentive. WellthCare, the first Health-to-Wealth™ Benefit System, replaces penalty-based compliance with positive incentives that build health and wealth together. By turning verified preventive health actions into real, spendable dollars at the WellthCare Store™ and automatic retirement contributions funded by savings employers commit, WellthCare ties employee actions to long-term financial and physical well-being. This health-to-wealth approach does more than penalties ever could: it makes engaging in the healthcare system rewarding, not just a way to avoid a fine.
The federal penalty for individuals is $0, but state-level penalties exist in several places, and employer mandate penalties are still alive and costly. The smartest companies are moving beyond a compliance-only mindset. They're building benefits ecosystems that show value, drive engagement, and create real wealth for employees, turning healthcare from a perceived cost into a visible, compounding investment.
This article is for general information only and is not legal, tax, or medical advice. Employers should consult their own advisors.