Is Health Insurance Required in Massachusetts: Rules and Penalties

Yes. Health insurance is required in Massachusetts for nearly every adult resident, and the state enforces the requirement through a tax penalty collected by the Department of Revenue. The rule has been in place since 2006, and unlike the federal individual mandate, Massachusetts still assesses and collects money from people who go without qualifying coverage.¹

Who Has to Carry Coverage

The mandate applies to every Massachusetts resident aged 18 or older. Under Chapter 111M of the Massachusetts General Laws, those individuals must obtain and maintain “creditable coverage” for the entire time they live in the Commonwealth.²

You count as a resident for mandate purposes in two ways. Your home is in Massachusetts for the full tax year, or you aren’t domiciled in the state but keep a permanent place to live there and spend more than 183 days of the tax year in Massachusetts.³ If you move into or out of the state mid-year, the requirement covers the months you lived there.

What Counts as Qualifying Coverage

Not every health plan satisfies the mandate. Your insurance has to meet Massachusetts Minimum Creditable Coverage (MCC) standards, set in state regulation at 956 CMR 5.00 and administered by the Health Connector.⁴ A qualifying plan has to cover core medical care (doctor visits, hospital stays, outpatient surgery, emergency care, prescription drugs, and mental health and substance use treatment), provide annual preventive care with no cost-sharing,⁵ keep deductibles at or below $3,200 for individual and $6,400 for family coverage in 2026,⁶ and place no annual or per-illness cap on benefits.⁷

Dental-only, vision-only, and fixed-dollar-per-hospital-day plans do not qualify. Most employer-sponsored plans and every plan sold through the Massachusetts Health Connector do. Massachusetts-licensed insurers are required to say on the plan itself whether the coverage meets MCC.⁷

One place to look closely: an employer plan issued out of state. Those insurers aren’t required to label their plans for MCC compliance, so you may need to check the plan documents against the deductible caps and preventive care rules yourself. If your only offered plan didn’t meet MCC, that fact can support a penalty appeal.⁷

The Penalty if You Go Without

If you spend part or all of the year without qualifying coverage, the Department of Revenue calculates a penalty when you file your state income tax return. The penalty is monthly, and the yearly total is capped at half the cost of the cheapest qualifying plan available to you.²

Actual dollar amounts scale with your income measured against the Federal Poverty Level. For tax year 2025, the most recent schedule published, penalties for a full uncovered year run from no penalty at or below 150% FPL, to $25 per month ($300 per year) just above that threshold, up to $187 per month ($2,244 per year) for income above 500% FPL.¹ Between those endpoints the penalty is set at half the cheapest ConnectorCare premium at your income; above 500% FPL it’s half the cheapest Bronze plan premium. The Department of Revenue reissues the schedule each year in a Technical Information Release, usually in early spring.

The collection mechanism catches people by surprise. If you were due a refund, the state applies it against the penalty first and sends you whatever is left. If the refund doesn’t cover the penalty, you get a bill for the balance.

When You Owe Nothing Even Without Coverage

The mandate is designed not to punish people who genuinely couldn’t afford insurance or who had short, ordinary gaps.

The Affordability Test

Each year the Health Connector publishes an affordability schedule setting the maximum share of income you should have to spend on premiums. If the cheapest MCC-qualifying plan available to you costs more than that share, you owe no penalty. For 2026, the individual thresholds start at 0% of income at or below 150% FPL (coverage must be free to be considered affordable) and climb to 8.00% of income above 400% FPL.⁸ You claim this on Schedule HC when you file; no separate appeal is needed.

Short Coverage Gaps

The statute permits a lapse of up to 63 days with no penalty.² The Health Connector describes this in practice as up to three consecutive calendar months.⁹ If your gap runs longer, the penalty applies to every uncovered month, not just the ones past the grace period.

Financial Hardship

Even when the schedule says a plan was technically affordable, you can appeal on hardship grounds. Qualifying situations include homelessness or being more than 30 days behind on rent or mortgage, a utility shutoff notice, a sudden jump in essential expenses from events like domestic violence, the death of someone who shared household costs, or damage from a fire, flood, or natural disaster, having to choose between insurance and basic necessities, a family size that doesn’t fit the standard schedule, and having only a non-MCC employer plan available.⁷

Religious Exemption

Individuals whose sincerely held religious beliefs conflict with accepting medical treatment can file for an exemption.

Proving Coverage at Tax Time

Every resident filing a Massachusetts return has to complete Schedule HC (Health Care Information). That’s how the Department of Revenue confirms you had MCC.²

Your insurer sends you Form MA 1099-HC, a Massachusetts-specific document confirming your plan met MCC.¹⁰ The insurer name, federal identification number, and subscriber number go on Schedule HC along with the months you had coverage. If you never got a 1099-HC (out-of-state plans sometimes don’t generate one), you can still complete Schedule HC using the identification number from your insurance card and marking each month you had MCC-level coverage for at least 15 days.¹¹

To appeal a penalty on hardship grounds, mark the appeal oval on Schedule HC, attach pages 1 through 3, and do not enter a penalty amount on your income tax return. Don’t send documentation with the return — the Health Connector will write to you asking for your written grounds and supporting materials, and may schedule a phone or in-person hearing where you’ll state your claims under oath.¹² The Department of Revenue holds the penalty while the appeal is pending.⁹ Missing the Connector’s response deadline results in dismissal, and a denial or dismissal produces a bill from the Department of Revenue with no further appeal through this process.

How to Get Covered

Massachusetts has built out several coverage pathways so cost is rarely a defensible reason to go uninsured.

MassHealth, the state’s Medicaid program, covers residents with income at or below 138% of the Federal Poverty Level (roughly $22,000 for a single person in 2026) at no premium.¹³ MassHealth enrollment is open year-round, so a job loss or income drop lets you apply immediately.

ConnectorCare offers subsidized plans through the Massachusetts Health Connector for residents earning between 100% and 400% FPL, with no deductibles, low copays, and $0 premiums at the lowest income tier.¹⁴ Some chronic-condition medications (for diabetes, asthma, and high blood pressure) come at no cost through these plans.

Most residents get their coverage through an employer plan that meets MCC. If yours does, enrolling satisfies the mandate. People above the subsidy thresholds can buy unsubsidized plans through the Connector or directly from insurers.

Connector plans have an enrollment window. For 2026 coverage, open enrollment ran from November 1, 2025 through January 23, 2026.¹⁵ Outside that window you’ll need a qualifying life event, such as losing existing coverage, moving, marriage, or the birth or adoption of a child, to open a Special Enrollment Period of generally 60 days.¹⁶

1
Mass.gov. TIR 25-1: Individual Mandate Penalties for Tax Year 2025
2
General Court of Massachusetts. Massachusetts General Laws Chapter 111M – Section 2
3
Mass.gov. Legal and Residency Status in Massachusetts
4
Cornell Law Institute. 956 CMR 5.00 – Minimum Creditable Coverage
5
Cornell Law Institute. 956 CMR 5.03 – Minimum Creditable Coverage
6
Massachusetts Health Connector. Proposed 2026 Affordability Schedule and MCC Deductible Limits
7
Mass.gov. Health Care Reform for Individuals
8
Massachusetts Health Connector. Affordability Schedule
9
Massachusetts Health Connector. Massachusetts Individual Mandate
10
Mass.gov. 1095-B and 1099-HC Tax Form
11
Mass.gov. 2025 Massachusetts Schedule HC Instructions
12
Mass.gov. Learn How to Appeal the Health Care Penalty
13
Mass.gov. 2026 MassHealth Income Standards and Federal Poverty Guidelines
14
Massachusetts Health Connector. ConnectorCare Plans
15
Mass.gov. Massachusetts Health Insurance Open Enrollment: What Massachusetts Residents Need to Know
16
HealthCare.gov. Special Enrollment Periods