Is There a Penalty for Not Having Health Insurance in NY?

There is no penalty for not having health insurance in New York. Neither the state nor the federal government will charge you a fine, fee, or tax for being uninsured. The federal individual mandate penalty dropped to $0 starting with the 2019 tax year, and New York never passed its own replacement. Skipping coverage still carries real financial risk, but it will not cost you anything on your tax return.

Why New York Doesn’t Fine You

The Affordable Care Act originally required most Americans to carry health insurance or pay a penalty on their federal tax return. That penalty was the greater of a flat dollar amount ($695 per adult, $347.50 per child, up to $2,085) or 2.5 percent of household income.¹ The Tax Cuts and Jobs Act of 2017 zeroed that penalty out.²

The mandate itself technically still exists in the tax code. Section 5000A says you’re “required” to have minimum essential coverage, but the applicable dollar amount is $0 and the percentage of income is zero for all taxable years after 2018.³ A law with no financial consequence is a suggestion.

After the federal penalty was zeroed, several states passed their own individual mandates. New York considered doing the same, but no bill became law. The state instead focused on making coverage cheaper, primarily by expanding the Essential Plan and layering additional subsidies onto marketplace coverage.

If You File Taxes in Another State

A handful of states do enforce their own individual mandate penalties. California, the District of Columbia, Massachusetts, New Jersey, and Rhode Island charge residents who go without qualifying coverage. Massachusetts has had its mandate since 2006; the others adopted theirs after the federal penalty was zeroed. Vermont has a mandate on the books but attaches no financial penalty to it.

These state penalties generally mirror the old federal structure, calculated as either a flat dollar amount per person or a percentage of income, whichever is higher. Massachusetts publishes updated penalty schedules each tax year based on income and age.⁴ If you split time between New York and one of these states, or file taxes in one of them, you could owe there even though New York charges nothing.

What Being Uninsured Actually Costs

No government penalty doesn’t mean no consequences. Roughly one in five Americans experiences a major illness or medical expense in any given year, and a hospital stay can easily run $20,000 or more.⁵ Uninsured patients are billed at rates far higher than what insurers negotiate, and a single emergency can generate debt that follows you for years.

Medical debt can also end up on your credit report. A federal rule that would have removed medical bills from credit reports was struck down by a federal court in July 2025, so unpaid medical debt remains reportable under the Fair Credit Reporting Act as long as it doesn’t identify your specific provider or the nature of your treatment.⁶ An uninsured hospital visit can affect your ability to rent an apartment, get a car loan, or qualify for a mortgage.

People without coverage also skip preventive screenings, delay care until problems become emergencies, and pay more when they finally seek treatment.

Low- and No-Cost Coverage in New York

Depending on your income, you may qualify for coverage that costs nothing at all.

The Essential Plan

The Essential Plan is New York’s option for lower-income residents who earn too much for Medicaid. It charges $0 monthly premiums and has no deductible across all plan levels. Eligibility expanded in April 2024, and the plan now covers New Yorkers at several income tiers:⁷

Essential Plan 4 (below 100% FPL): $0 out-of-pocket maximum; includes non-emergency transportation and non-prescription drugs
Essential Plan 3 (100–138% FPL): $200 out-of-pocket maximum; same additional benefits as Plan 4
Essential Plan 2 (138–150% FPL): $200 out-of-pocket maximum
Essential Plan 1 (150–200% FPL): $360 out-of-pocket maximum
Essential Plan 200–250 (200–250% FPL): $2,000 out-of-pocket maximum

For a single person in 2026, 250% of the federal poverty level is about $39,900 per year.⁸ Every Essential Plan level includes dental and vision coverage, free preventive care, and prescription drug coverage. Enrollment is open year-round.⁷

Medicaid

New York expanded Medicaid under the ACA, covering adults with incomes up to 138% of the federal poverty level, roughly $22,025 for an individual in 2026. Medicaid has no premiums, no deductibles, and minimal copays. Enrollment is open year-round. If your income is low enough, this is the first program to check.

Marketplace Plans With Subsidies

If you earn too much for the Essential Plan, you can shop for a Qualified Health Plan on NY State of Health, the state’s ACA marketplace. Federal premium tax credits are available to households with income between 100% and 400% of the federal poverty level, which for a single person in 2026 means roughly $15,960 to $63,840.⁹⁸

One wrinkle for 2026: the enhanced premium tax credits that eliminated the 400% FPL income cliff expired at the end of 2025. The House passed a three-year extension in January 2026, but the bill still requires Senate approval.¹⁰ If the extension does not pass, people earning above 400% FPL would lose access to subsidies entirely, and those below the threshold would see their credits shrink. Check NY State of Health for current subsidy amounts when you apply.

When You Can Enroll

For Qualified Health Plans on the marketplace, open enrollment for 2026 coverage ran from November 1, 2025 through January 31, 2026. Enrolling by December 15, 2025 locked in a January 1 start date.¹¹ If you missed that window, you generally need a qualifying life event to trigger a Special Enrollment Period.

Qualifying life events include:

Losing existing coverage: a job-based plan ends, you age off a parent’s plan at 26, or you lose Medicaid or CHIP eligibility
Household changes: marriage, divorce, having or adopting a child
Moving to a different ZIP code or county
Income changes that affect what you qualify for, gaining U.S. citizenship, or being released from incarceration

These events typically give you 60 days to enroll.¹² The Essential Plan and Medicaid work differently. Both allow enrollment year-round with no special event required, so if you qualify for either, there’s no reason to wait.⁷

1
Tax Policy Center. How Did the Tax Cuts and Jobs Act Change Personal Taxes
2
Internal Revenue Service. Questions and Answers on the Individual Shared Responsibility Provision
3
Office of the Law Revision Counsel. 26 US Code 5000A – Requirement to Maintain Minimum Essential Coverage
4
Mass.gov. TIR 26-1 Individual Mandate Penalties for Tax Year 2026
5
Johns Hopkins Bloomberg School of Public Health. Navigating an Unaffordable Health Insurance Market
6
Consumer Financial Protection Bureau. CFPB Finalizes Rule to Remove Medical Bills from Credit Reports
7
NY State of Health. Essential Plan Information
8
U.S. Department of Health and Human Services. 2026 Poverty Guidelines 48 Contiguous States
9
Internal Revenue Service. Eligibility for the Premium Tax Credit
10
American Hospital Association. House Passes Bill Extending Enhanced Premium Tax Credits
11
New York State Department of Health. New York State Department of Health Announces Open Enrollment
12
HealthCare.gov. Qualifying Life Event (QLE)