The California health insurance penalty for the 2025 tax year, paid on the return you file in spring 2026, is the greater of $950 per uninsured adult ($475 per child under 18) or 2.5% of household income above the state filing threshold, prorated for the months you actually went without coverage.1Franchise Tax Board. Personal Health Care Mandate California kept its individual mandate after the federal penalty dropped to zero at the end of 2018, and the Franchise Tax Board (FTB) collects the charge through your state income tax return. Plenty of people who went uncovered still owe nothing once exemptions are applied, so the amount above is a starting point, not a verdict.
How Much You Actually Owe
The FTB runs two calculations and charges the larger one, then trims the result by the cost cap and by the months you were covered.1Franchise Tax Board. Personal Health Care Mandate
The Flat Amount
For 2025, the flat penalty is $950 per uninsured adult (18 or older) and $475 per uninsured child.1Franchise Tax Board. Personal Health Care Mandate The total is capped at three times the adult rate, so a household cannot owe more than $2,850 under this method for a full year without coverage.2Covered California. Individual Mandate and Penalty Quick Guide A single uninsured adult owes $950. A family of four, all uncovered, hits the cap.
The Percentage of Income
The second calculation is 2.5% of household income above the California filing threshold.1Franchise Tax Board. Personal Health Care Mandate The threshold varies by age, filing status, and dependents. A single filer under 65 with no dependents has a 2025 gross income filing threshold of $22,941.3Franchise Tax Board. 2025 Instructions for Form FTB 3853 Subtract the threshold from your income, multiply by 2.5%, and compare that figure to the flat amount. Higher earners generally pay under this method.
The Bronze Plan Cap
Whatever the two calculations produce, the penalty cannot exceed the cost of an average statewide Bronze-level Covered California plan sized to your household.2Covered California. Individual Mandate and Penalty Quick Guide For 2025, that cap for a single person is $4,524, and it scales up with family size.3Franchise Tax Board. 2025 Instructions for Form FTB 3853
Proration by Month
The annual penalty is divided by 12 and charged only for months without coverage. A three-month gap costs about a quarter of the full-year amount. Each household member is counted separately, so one person’s four uncovered months and another’s one uncovered month are added up individually.
What Coverage Keeps You Out of the Penalty
The law requires minimum essential coverage (MEC) for you, your spouse or registered domestic partner, and every dependent you claim, in every month of the year.1Franchise Tax Board. Personal Health Care Mandate Most real health insurance qualifies:
- Employer-sponsored plans, including COBRA and retiree coverage
- Covered California plans
- Medicare Part A and Medicare Advantage (Part C)
- Medi-Cal
- TRICARE, VA health care, and CHIP
- ACA-compliant individual market plans bought directly from an insurer
Dental-only, vision-only, accident, and disability policies do not satisfy the mandate. Health care sharing ministries are not MEC, though members qualify for a separate exemption.1Franchise Tax Board. Personal Health Care Mandate Short-term health insurance plans cannot be sold in California; the state banned them effective January 1, 2019.5California Department of Insurance. Prohibition Regarding Short-Term Limited Duration Health Insurance (SB 910) Anything advertised as short-term either cannot legally cover a California resident or will not satisfy the mandate.
Who Is Exempt
Exemptions split into two groups: ones you claim directly on the tax return, and ones that require an Exemption Certificate Number (ECN) from Covered California before you file.
Short Coverage Gap
A gap of fewer than three consecutive months is automatically exempt, no paperwork required. Two separate gaps in the same year can each qualify on their own, so long as neither runs three months or longer.6Centers for Medicare & Medicaid Services. Exemption Information if You Had a Gap in Health Coverage Hit three months in a row and you owe for every one of them.
Affordability
If the lowest-cost coverage available to you would have cost more than a set share of household income, you qualify for the affordability exemption. For 2025 the threshold is 7.28% of household income; for 2026 coverage it rises to 8.05%.7Covered California. Affordability Hardship Exemption The comparison uses either the lowest-cost Bronze plan on Covered California or the lowest-cost employer plan offered to you.
Income Below the Filing Threshold
Households below California’s filing threshold owe no penalty. For 2025, that threshold is $22,941 in gross income for a single filer under 65 with no dependents, and $45,887 for a married couple filing jointly, both under 65, no dependents.3Franchise Tax Board. 2025 Instructions for Form FTB 3853
Other Categories
Additional exemptions cover hardship (such as eviction, domestic violence, bankruptcy, or a natural disaster), members of a health care sharing ministry, members of a federally recognized Indian tribe, incarcerated individuals, non-residents of California, and U.S. citizens living abroad.1Franchise Tax Board. Personal Health Care Mandate Hardship and religious conscience exemptions require an ECN from Covered California before you file. The rest are claimed on Form FTB 3853 at tax time.
Getting Covered Now
If you do not have access to employer coverage, Medicare, or Medi-Cal, Covered California is the usual route. Open enrollment for 2026 coverage runs from November 1, 2025 through January 31, 2026, with a December 31 deadline for coverage effective January 1.8Covered California. Covered Californias Open Enrollment 2026
Outside open enrollment, a qualifying life event opens a special enrollment period. Qualifying events include marriage, birth or adoption, losing existing coverage, moving to California, and turning 26 and aging off a parent’s plan.9Covered California. Special Enrollment If your lapse before the new plan starts stays under three months, the short-gap exemption absorbs it.
Medi-Cal has no enrollment window. If your income qualifies, you can apply any time of year through Covered California or your county social services office.
Reporting It on Your Tax Return
Everything mandate-related runs through Form FTB 3853, Health Coverage Exemptions and Individual Shared Responsibility Penalty, attached to Form 540 or Form 540NR.3Franchise Tax Board. 2025 Instructions for Form FTB 3853 If everyone in the household had coverage all year, you check the full-year coverage box on Form 540 and skip Form 3853 entirely.
Otherwise, Form 3853 walks through each household member month by month, records any ECNs from Covered California, and produces the penalty figure, which then carries over to your Form 540 and gets paid with the rest of your state tax by the April deadline. Skipping the form does not make the issue go away; the FTB can assess the penalty using the income data it already holds, and doing so may cost more than filing a form that claims an exemption you were entitled to.
Disputing a Penalty or a Denied Exemption
If Covered California denies your exemption application, you can request a State Fair Hearing by downloading and submitting the appeal form from Covered California’s website.10Covered California. File an Appeal or Complaint
If the FTB has already assessed a penalty and you believe it is wrong, the dispute runs through the FTB’s protest process rather than Covered California. You generally have 60 days from the date on the notice to file a written protest. Keep documentation of your coverage months, exemption eligibility, and any ECNs. Without records, the argument comes down to your memory against the FTB’s data.