California Individual Health Insurance Mandate and Penalty

If you went without health insurance in California during 2025, the state penalty is the greater of $950 per uninsured adult and $475 per uninsured child, or 2.5% of your household income above the state filing threshold, whichever is larger. The California health insurance penalty is capped at the annual cost of the state’s average bronze-level plan, and it’s prorated by the month, so a short gap costs far less than a full year without coverage.¹

How the Penalty Is Calculated

California Revenue and Taxation Code Section 61015 sets up a three-step calculation. Most online estimators skip the middle step and overstate what people owe.²

Step One: The Greater of Two Amounts

The Franchise Tax Board runs two numbers and takes the larger:

Flat-dollar amount: $950 per uninsured adult and $475 per uninsured child under 18, capped at $2,850 per household no matter how many members are uninsured.¹
Income-based amount: 2.5% of household income above the California filing threshold for your filing status. For 2025, that threshold is $22,941 for a single filer under 65 with no dependents, and $45,887 for a married couple filing jointly under those same conditions.³

Step Two: The Bronze Plan Cap

Whatever Step One produces, the penalty cannot exceed the annual cost of California’s average bronze plan for your household size. The 2025 monthly average is $377 per person. Annual caps:

1 person: $4,524
2 people: $9,048
3 people: $13,572
4 people: $18,096
5 or more: $22,620

You pay the lesser of the Step One figure or this cap.⁴

Step Three: Prorating by Month

The penalty is monthly. If you were uninsured for four months, you owe one-third of the annual figure. A short lapse of three consecutive months or less triggers no penalty at all.²

Worked Examples

A single adult earning $60,000 and uninsured all year: the flat amount is $950; 2.5% of ($60,000 − $22,941) is about $927. The flat figure wins at $950, well under the $4,524 bronze cap. Penalty owed: $950.

A single adult earning $150,000 and uninsured all year: 2.5% of income over the threshold is about $3,177, which beats the flat $950 and still sits under the $4,524 cap. Penalty owed: $3,177.

A family of four uninsured all year: the flat amount maxes out at $2,850. The income-based number could run higher depending on earnings, but neither can exceed the $18,096 bronze cap.

Who the Mandate Applies To

If you’re a California resident for tax purposes, you need qualifying coverage. On a joint return, your spouse or registered domestic partner needs it too, as does every dependent you claim. A gap for any one person in the tax household can produce a penalty for that person’s months without coverage.¹

What Counts as Qualifying Coverage

Your plan has to meet the federal “minimum essential coverage” standard California adopted. Most everyday coverage qualifies:

Employer-sponsored group plans, fully insured or self-funded.
Individual-market plans, including anything bought through Covered California.
Medicare Part A or Part C, full-scope Medi-Cal, CHIP, TRICARE, and VA health benefits.
Grandfathered plans that predated the Affordable Care Act.

Short-term limited-duration policies, dental-only or vision-only plans, and restricted-scope Medi-Cal do not count.⁵ Your insurer should send a Form 1095-B or 1095-C each year confirming that your coverage qualifies.

Exemptions That Erase the Penalty

California recognizes a long list of exemptions. Some you claim directly on your return; others require a certificate from Covered California before you file.¹

Claimed on Your Return (FTB Form 3853)

Income below the state filing threshold.
Unaffordable coverage: the cheapest available plan would cost more than 7.28% of household income for 2025.
Short coverage gap of three consecutive months or less.
Membership in a qualifying health care sharing ministry.
Members of federally recognized tribes and Alaska Native Claims Settlement Act shareholders.
Months of incarceration after disposition of charges.
Months before a child’s birth or adoption, or after a household member’s death.
Non-citizens not lawfully present, and residents of another state or U.S. territory.
Enrollment in restricted-scope Medi-Cal or similar limited coverage.

Requires Covered California Approval First

Religious conscience, for members of recognized sects whose established beliefs oppose accepting medical care benefits.
Affordability hardship, based on Covered California’s review of your projected income.
General hardship, which can include homelessness, eviction, domestic violence, bankruptcy, a death in the family, a natural disaster that damaged your property, or unpayable medical debt. The exemption usually covers the month before the hardship, the months during, and the month after.

How to Get Covered and Stop the Clock

If you don’t have insurance through a job or a public program, Covered California is the state marketplace for individual and family plans. Premium assistance reaches further up the income scale here than in most states; some families earning up to $154,500 a year qualify.⁶

Open enrollment for 2026 coverage runs through January 31, 2026. Enroll by December 31 to have coverage effective January 1 with no gap.⁷ Outside open enrollment, you can sign up after a qualifying life event: losing other coverage, getting married, having a baby, or moving to California. California also opens a special enrollment period for anyone who paid the mandate penalty on a prior return, giving you a second window to enroll instead of paying again.⁸

Reporting Coverage on Your State Return

Coverage status is reported on Form 540. If every member of your household had qualifying coverage all 12 months, you check the box on line 92 and no additional form is required.⁹

If anyone had a gap or qualifies for an exemption, complete FTB Form 3853. You list each uninsured person, the months they lacked coverage, and any exemption code that applies (Code A for unaffordable coverage, Code C for a short gap, Code H for incarceration, and so on). The penalty computed on Form 3853 flows to Form 540 and either reduces your refund or adds to the tax you owe.⁴

What Happens If You Don’t Pay

Insurers and employers report coverage to the IRS on Forms 1094 and 1095, and federal law lets the IRS share that data with state tax agencies running their own mandates.¹⁰ The FTB uses it to cross-check your return.

The old federal mandate penalty was unusually weak on collection: the IRS could only offset future refunds and was barred from using liens or levies.¹¹ California has no such limit. The mandate penalty becomes part of your state income tax balance, and the FTB collects unpaid balances with its standard tools, including state tax liens and bank levies. Unpaid amounts accrue interest.¹²

Figures Change Each Year

Both the per-person flat amount and the bronze plan cap adjust annually. The $950 adult, $475 child, and bronze cap figures above apply to the 2025 tax year. Confirm the current numbers against the FTB website or the Form 3853 instructions for your filing year before you calculate; older calculators often quote outdated amounts.¹

1
Franchise Tax Board. Personal Health Care Mandate
2
California Legislative Information. California Revenue and Taxation Code 61015
3
Franchise Tax Board. Residents – FTB.ca.gov
4
Franchise Tax Board. 2025 Instructions for Form FTB 3853
5
eCFR. 26 CFR 1.5000A-2 – Minimum Essential Coverage
6
Covered California. California Subsidy
7
Covered California. Covered California Open Enrollment 2026
8
Covered California. Major Life Changes – Qualifying Life Events
9
Franchise Tax Board. 2025 Instructions for Form 540
10
Internal Revenue Service. Instructions for Forms 1094-B and 1095-B
11
Internal Revenue Service. Questions and Answers on the Individual Shared Responsibility Provision
12
Franchise Tax Board. FTB 1140 Personal Income Tax Collections Information