If you don’t have health insurance in Massachusetts, you’ll owe a state tax penalty of up to $2,244 for the year, and you’ll be on the hook for the full cost of any medical care you need. The state has run its own individual mandate since 2007, and it’s still enforced through your state income tax return even though the federal penalty went to $0 in 2019.
The State Tax Penalty
Massachusetts law requires most residents 18 and older to carry health insurance that meets state standards, as long as a qualifying plan is considered affordable for them.1Mass.gov. Health Care Reform for Individuals The Department of Revenue administers the penalty.2Mass.gov. TIR 25-1: Individual Mandate Penalties for Tax Year 2025
When you file your state return, you complete Schedule HC (Health Care Information) listing which months you had coverage and whether that coverage met the state’s Minimum Creditable Coverage standards. The penalty is calculated there and added to your Form 1. If you’re owed a refund, it comes out of the refund. If you already owe, it stacks on top.1Mass.gov. Health Care Reform for Individuals
The amount depends on your household income as a percentage of the Federal Poverty Level (FPL). For tax year 2025, the annual penalties if you go the whole year without qualifying coverage are:2Mass.gov. TIR 25-1: Individual Mandate Penalties for Tax Year 2025
- At or below 150% FPL: no penalty
- 150.1–200% FPL: $300
- 200.1–250% FPL: $588
- 250.1–300% FPL: $876
- 300.1–400% FPL: $1,356
- 400.1–500% FPL: $1,584
- Above 500% FPL: $2,244
If you were uninsured for only part of the year, you owe the monthly share for the months you lacked coverage. By law, the monthly penalty can’t exceed 50% of the cheapest monthly premium you would have qualified for through the Massachusetts Health Connector.2Mass.gov. TIR 25-1: Individual Mandate Penalties for Tax Year 2025
The Federal Penalty Being Gone Doesn’t Help You in Massachusetts
This trips a lot of people up. The federal individual mandate penalty under the Affordable Care Act dropped to $0 starting with the 2019 tax year.3HealthCare.gov. Exemptions from the Requirement to Have Health Insurance Massachusetts runs a separate mandate with its own penalty schedule. Owing nothing to the IRS for being uninsured doesn’t mean you owe nothing to the Massachusetts Department of Revenue.
When You Won’t Owe the Penalty
Several situations let you go without coverage and face no financial consequence on your state return. You claim them on Schedule HC when you file.1Mass.gov. Health Care Reform for Individuals
Income at or Below 150% FPL
At that income level you’d qualify for ConnectorCare with no premium, so the state doesn’t penalize you for not enrolling.2Mass.gov. TIR 25-1: Individual Mandate Penalties for Tax Year 2025
A Short Gap in Coverage
A lapse of three consecutive calendar months or fewer doesn’t trigger a penalty. The Health Connector reads the statutory 63-day language as three calendar months, and you can have more than one short gap in a year as long as no single gap goes past that window.1Mass.gov. Health Care Reform for Individuals Lose a job in March, get new coverage by June, no penalty.
Affordability
If the cheapest plan available to you through the Health Connector would have cost more than a set percentage of your income, you’re exempt. The Health Connector publishes an affordability schedule each year with the exact threshold for each income level.
Hardship
You can appeal the penalty to the Health Connector if a specific hardship kept you from buying coverage. Homelessness, eviction, domestic violence, and a death in the family are examples; the Health Connector reviews these case by case.2Mass.gov. TIR 25-1: Individual Mandate Penalties for Tax Year 2025
Religious Beliefs
If sincerely held religious beliefs prevent you from accepting medical care, you can claim an exemption by filing a sworn statement with your return.
What Counts as Qualifying Coverage
Not every health plan satisfies the Massachusetts mandate. Coverage must meet the state’s Minimum Creditable Coverage (MCC) standards. Most employer plans and every plan sold through the Health Connector meet MCC, but if your coverage comes from another source it’s worth confirming. Your insurer indicates on Form MA 1099-HC whether your plan qualifies.
For 2026, MCC plans must keep deductibles within these limits:4Massachusetts Health Connector. Board Memo Proposed 2027 Affordability Schedule and MCC Deductible Limits
- Individual deductible: $3,200 or less
- Individual prescription drug deductible: $400 or less
- Family deductible: $6,400 or less
- Family prescription drug deductible: $800 or less
MCC plans must also cover a core set of benefits including preventive care, hospitalization, outpatient services, mental health treatment, and prescription drugs. A plan with a deductible above those limits or missing required categories leaves you treated as uninsured for penalty purposes even though you’re paying premiums.
The Bigger Risk Is the Medical Bill
Even at its maximum of $2,244 a year, the tax penalty is a small concern next to what happens when an uninsured person needs care. A single emergency room visit for something routine can run into the thousands once you add the facility charge, physician fees, and any imaging or lab work. A broken bone, a kidney stone, an appendicitis diagnosis: none of these are exotic events, and they happen to healthy people without warning. A multi-day hospital stay can produce a bill in the tens of thousands. Surgery pushes those numbers higher. None of those figures include follow-up visits, medications, or rehabilitation.
Some Massachusetts hospitals offer financial assistance or charity care for uninsured patients, and the state’s Health Safety Net helps cover emergency and essential services for people who qualify based on income. These are partial backstops. They don’t cover everything, they often involve extensive paperwork after the fact, and they don’t protect you from the full billing rate at every facility. Insurance negotiates rates down before you ever see a bill. Without it, you’re exposed to the chargemaster price, which bears little resemblance to what insurers actually pay.
How to Get Covered
If you’re currently uninsured, the Massachusetts Health Connector at MAhealthconnector.org is the state marketplace and the only place to apply for premium subsidies and tax credits.5Massachusetts Health Connector. Massachusetts Health Connector Home One application checks you for every program at once.
If your household income is between 100% and 400% of the Federal Poverty Level, you may qualify for ConnectorCare, which offers heavily subsidized plans with low premiums and reduced copays, with no premium at all at the lowest income tier.6Massachusetts Health Connector. Can You Get Help Paying for Health Insurance Through the Health Connector? At lower incomes, the system routes you to MassHealth, the state’s Medicaid program, which covers members at no cost or very low cost; MassHealth members at or below 150% FPL pay no premiums.7Division of Medical Assistance. 130 CMR 506.000 – MassHealth Financial Requirements
Open Enrollment for 2026 coverage began November 1, 2025, and Massachusetts sets its own end date, which typically runs past the federal deadline into late January. Outside Open Enrollment, you can enroll only through a Special Enrollment Period triggered by a qualifying life event: losing other coverage, moving, marriage or a new child, or an income change that newly qualifies you for subsidies or MassHealth. You generally have 60 days from the event to enroll.8Centers for Medicare & Medicaid Services. Understanding Special Enrollment Periods MassHealth and ConnectorCare applications at certain income levels can be submitted year-round.
If you miss Open Enrollment and don’t qualify for a special enrollment period, you wait until next fall, and you owe the monthly penalty for every month you go uncovered in the meantime.