Maryland does not charge a penalty for not having health insurance. No fine, fee, or tax surcharge applies to uninsured residents at either the state or federal level. Instead of punishing people who go without coverage, Maryland uses its tax return to connect uninsured residents with free or low-cost plans.
The Federal and State Picture
The federal Shared Responsibility Payment, the fine attached to the Affordable Care Act’s individual mandate, dropped to $0 for all months after December 31, 2018, under the Tax Cuts and Jobs Act.1Internal Revenue Service. Affordable Care Act Tax Provisions for Individuals and Families The requirement to carry coverage still sits in federal law. The dollar consequence does not.
A few states filled the gap by writing their own penalties: California, the District of Columbia, Massachusetts, New Jersey, and Rhode Island all charge residents who go uninsured. Maryland did not take that route. When the state built its own coverage framework in 2019 through the Maryland Easy Enrollment Health Insurance Program, it was designed to connect people with affordable plans rather than to fine them for being uncovered.2Maryland General Assembly. SB0802 – Maryland Easy Enrollment Health Insurance Program
So if you file your Maryland return without coverage, you owe nothing extra for it. The state will, however, ask about your coverage status, and that question has a purpose.
What Maryland Does Instead
Page 2 of Maryland Form 502 includes a health care coverage section. You check a box if you or your spouse lack coverage, provide a date of birth, and decide whether to authorize the Comptroller to share your tax information with Maryland Health Connection.3Maryland Comptroller. Maryland Form 502 Resident Income Tax Return
Checking that authorization box is the whole Easy Enrollment Program. If you file by April 15, Maryland Health Connection reviews your income and household size, mails you a letter explaining what you qualify for, and gives you 35 days from the date on that letter to pick a plan. The 35-day window works like a special enrollment period, so it opens the door to coverage even outside the usual open enrollment calendar.4Maryland Health Connection. Easy Enrollment Program
The box is voluntary. Checking it does not commit you to buying anything, and ignoring the letter costs you nothing. Reporting that you’re uninsured is not a confession that triggers a bill; it’s a data point that gets you a quote.
Help Paying for Coverage If You Want It
Last year, nine out of ten people who enrolled through Maryland Health Connection qualified for some form of financial help.5Maryland Health Connection. Financial Help For many Maryland residents, the real question behind “is there a penalty” is whether coverage is worth the money. The assistance programs are the reason that math often works out.
Medicaid and the Maryland Children’s Health Program
If your income is low enough, Medicaid covers your care with no monthly premium. The 2025 approximate monthly income limits are $1,801 for a single adult and $3,698 for a family of four. Children qualify at higher thresholds through the Maryland Children’s Health Program, with limits of $4,202 per month for one child and $8,630 for a family of four. Pregnant residents see expanded eligibility, with monthly limits running from $4,654 for a household of two up to $11,914 for a household of eight.6Maryland Health Connection. Medicaid Coverage Factsheet
Premium Tax Credits and the Maryland Premium Assistance Program
If you earn too much for Medicaid, two programs stack to lower what you pay each month. Federal Advance Premium Tax Credits reduce marketplace premiums based on household income. On top of that, the Maryland Premium Assistance Program adds state-funded help for residents earning less than 400% of the federal poverty level.5Maryland Health Connection. Financial Help More than 177,000 Marylanders currently use that state subsidy.7Office of the Governor. Open Enrollment Data Show Maryland Premium Assistance Program Helps
Young Adult Subsidy Starting in 2026
Beginning in 2026, Maryland is launching a dedicated subsidy for young adults aged 18 to 40 who buy individual coverage through Maryland Health Connection. To qualify, your income must fall between 133% and 400% of the federal poverty level. For eligible young adults whose expected contribution is $0, the subsidy covers 100% of the premium.8New York Codes, Rules and Regulations. Maryland Code – State-Based Young Adult Health Insurance Subsidies Program The program targets the age group most likely to skip coverage on cost.
Why Coverage Still Matters Without a Penalty
No fine does not mean no risk. A single emergency room visit can reach thousands of dollars, and uninsured patients routinely pay more than insured patients for identical services because they lack the negotiated rates that insurance carriers secure. Maryland’s bankruptcy protections are also less generous than those in many states, which can make medical debt harder to discharge if it spirals.
Going without coverage also means paying out of pocket for preventive care that marketplace plans cover with no cost-sharing, including screenings, immunizations, and annual checkups. With most Maryland residents eligible for help that brings monthly premiums down to a few dollars or zero, the cost of staying covered is often lower than people assume. Checking the Easy Enrollment box when you file is the lowest-effort way to find out what a plan would actually cost you.
A Note on Exemptions
Because there is no penalty, you don’t need an exemption to avoid one. Exemptions still exist in Maryland, processed through Maryland Health Connection rather than the federal marketplace, but they mainly matter if you want to buy a catastrophic plan, which is otherwise limited to people under 30.9HealthCare.gov. Exemptions From the Fee for Not Having Coverage A hardship exemption or an affordability exemption (available when the lowest-cost coverage would run more than 9.96% of household income for 2026) opens that door.10Internal Revenue Service. Revenue Procedure 2025-25 For most uninsured Marylanders, the exemption question never comes up, because the penalty it protects against doesn’t exist.