Is It Illegal to Not Have Health Insurance in Massachusetts?

No, it is not illegal to not have health insurance in Massachusetts in the criminal sense, but the state does require adult residents to carry coverage and enforces that requirement through a tax penalty that can reach $2,532 per year in 2026. Massachusetts kept its individual mandate in place after Congress zeroed out the federal penalty in 2019, so the consequences here are real and are assessed directly on your state income tax return.

Who Has to Be Covered

The requirement comes from Chapter 111M of the Massachusetts General Laws, enacted as part of Chapter 58 of the Acts of 2006. Every Massachusetts resident age 18 or older must obtain and maintain “creditable coverage,” meaning a plan that meets minimum standards set by the Commonwealth Health Insurance Connector Authority.¹ New residents have 63 days from the date they become residents to enroll, and anyone who loses existing coverage gets the same 63-day window to find a replacement.

Coverage can come from an employer plan, an individual policy bought through the Health Connector or directly from an insurer, MassHealth, Medicare, TRICARE, or a qualifying student health plan. What matters is not the source but whether the plan meets the state’s minimum creditable coverage standards.

The 63-Day Gap Rule

A gap of 63 consecutive days or fewer does not trigger a penalty at all.¹ If your gap runs longer than that, the penalty applies only to the months beyond the 63-day grace period, not the entire uninsured stretch. That matters for anyone between jobs, waiting for a new plan’s start date, or working through MassHealth eligibility.

What the Penalty Costs in 2026

The penalty scales with income as a percentage of the federal poverty level. For tax year 2026, the Massachusetts Department of Revenue set these amounts:²

At or below 150% FPL: no penalty (this income level qualifies for ConnectorCare with no enrollee premium)
150.1–200% FPL: $26 per month, up to $312 per year
200.1–250% FPL: $51 per month, up to $612 per year
250.1–300% FPL: $76 per month, up to $912 per year
300.1–400% FPL: $117 per month, up to $1,404 per year
Above 400% FPL: $211 per month, up to $2,532 per year

For incomes between 150.1% and 400% FPL, the penalty is set at half of the lowest-priced ConnectorCare enrollee premium available at that income level. Above 400% FPL, it’s half of the lowest-priced individual Bronze plan sold through the Health Connector.² The annual totals assume a full 12 months without coverage; a shorter uninsured stretch produces a proportionally smaller penalty. Married couples who both lack coverage owe the sum of each spouse’s individual penalty.

The penalty only applies to adults the state deems able to afford coverage. If available insurance would have cost more than your income bracket’s affordability threshold, no penalty is assessed.

How the Penalty Reaches You

Enforcement runs through the state income tax system. Every Massachusetts resident age 18 and older has to complete Schedule HC when filing a state return, whether they were covered all year, part of the year, or not at all.³ Schedule HC is where you report your coverage status, claim any exemption, or calculate the penalty.

To fill it out, you’ll use Form MA 1099-HC, which your insurer or MassHealth sends early each year. This state form is separate from the federal 1095 series and confirms whether your plan met minimum creditable coverage standards.⁴ You don’t attach the form to your return, but keep it with your records.

If you report a coverage gap and don’t qualify for an exemption, the Department of Revenue applies the penalty to your return. Any refund you’d otherwise receive can be reduced by up to the penalty amount, and if the refund doesn’t cover it, the state bills you for the balance.¹

Ways to Avoid the Penalty

Going without coverage doesn’t always mean owing money. Massachusetts recognizes several grounds for exemption.

Affordability

The Health Connector publishes an annual affordability schedule that caps the share of income a person is expected to spend on premiums. If the cheapest available plan exceeds that ceiling, coverage is treated as unaffordable and no penalty is due. For 2026, the individual thresholds run from 0% of income at or below 150% FPL up to 8% of income above 400% FPL.⁵ Couples and families use slightly different thresholds. The Department of Revenue applies these standards automatically when processing your return, so most people who qualify don’t file anything extra.

Religious Beliefs

If sincerely held religious beliefs cause you to object to substantially all forms of medical treatment covered by insurance, you can claim an exemption by checking the religious box on Schedule HC and signing your return; the signature satisfies the sworn statement requirement.³ The exemption is narrow. Objecting to a specific procedure but otherwise using standard care doesn’t qualify, and if you actually receive medical care during the tax year you lose the exemption and owe the penalty.

Hardship

Residents facing circumstances that kept them from getting coverage can appeal for a hardship exemption. Qualifying situations include homelessness, eviction, domestic violence, and loss of utilities, among others.² You can file the hardship appeal with the Health Connector before you file taxes, or claim it directly on Schedule HC.

Making Sure Your Plan Actually Counts

Having a health plan isn’t the same as having creditable coverage. The Health Connector’s Minimum Creditable Coverage (MCC) rules are stricter than the federal essential health benefits list, and a plan that falls short doesn’t shield you from the penalty for the months you were on it.

An MCC-compliant plan has to cover, at minimum:⁶

Ambulatory patient services, including outpatient surgery
Diagnostic imaging and screening procedures
Emergency services
Hospitalization (inpatient acute care)
Maternity and newborn care, including prenatal and postnatal care
Medical and surgical care, including preventive and primary care
Mental health and substance abuse services
Prescription drugs
Radiation therapy and chemotherapy

Preventive care has to be covered without a deductible, and prescription drug benefits can’t be capped.⁷ Deductible and out-of-pocket limits also apply. For plan years starting on or after January 1, 2026, the maximum MCC deductible is $3,200 for an individual and $6,400 for a family. A separate prescription drug deductible cannot exceed $400 individual or $800 family, and those amounts count toward the overall deductible cap. The maximum out-of-pocket limit for 2026 is $10,150 individual and $20,300 family. These figures rise most years, so a high-deductible plan that qualified last year should be checked against the current limits.

Appealing a Penalty You Think Is Wrong

If a penalty was assessed and you believe it shouldn’t have been, you can appeal to the Health Connector. The appeal must be received within 30 days of the date you receive the adverse notice; the state presumes you received the notice within five days of its mailing date. If you weren’t notified before the penalty was imposed, the deadline extends to 120 days from the date of the action. Hearings are usually held by telephone through the Health Connector’s Appeals Unit, and an adverse decision can be taken to court for judicial review under Massachusetts General Laws Chapter 30A, Section 14.

1
General Court of Massachusetts. Massachusetts General Laws Chapter 111M Section 2
2
Mass.gov. TIR 26-1: Individual Mandate Penalties for Tax Year 2026
3
Mass.gov. 830 CMR 111M.2.1 – Health Insurance Individual Mandate, Personal Income Tax Return Requirements
4
Massachusetts Health Connector. Get Your Health Coverage Tax Forms Together
5
Massachusetts Health Connector. Affordability Schedule
6
Massachusetts Health Connector. Minimum Creditable Coverage Requirements
7
Mass.gov. Health Care Reform for Individuals