Massachusetts Health Insurance Penalty: The State Coverage Requirement, the Tax Form and Exemptions

Massachusetts generally requires residents age 18 and older to have health coverage that meets the state's Minimum Creditable Coverage (MCC) standard, as long as affordable coverage is available to them. If you could have afforded qualifying coverage and went without it, the state can charge a penalty on your Massachusetts income-tax return. For tax year 2026, the monthly penalty ranges from $26 to $211 depending on household income, according to the Department of Revenue's TIR 26-1 (opens in a new tab) (checked October 1, 2026). The federal penalty has been zero since 2019, but that does not change the state rule. You report your coverage on Schedule HC, using Form MA 1099-HC.

Do you legally have to have health insurance in Massachusetts?

Yes, if you are an adult resident and affordable coverage is available to you. M.G.L. c. 111M (opens in a new tab) requires qualifying adults to obtain and keep creditable coverage when it is affordable, and the requirement applies generally to Massachusetts residents age 18 or older and to people who become residents, according to the Department of Revenue (opens in a new tab).

If you are new to the state, you must obtain coverage within 63 days of becoming a resident under 830 CMR 111M.2.1 (opens in a new tab). The same 63-day window applies when prior creditable coverage ends, such as after a job loss. Moving to Massachusetts permanently is also a qualifying life event for Health Connector enrollment, which gives you a route to buy coverage outside open enrollment.

Affordability is part of the rule, not an afterthought. The Health Connector sets annual affordability and premium schedules under 956 CMR 6.00 (opens in a new tab) that compare your household income, family size and the amount you would be expected to pay toward qualifying coverage. The Department of Revenue uses those Health Connector determinations rather than making its own call. Affordability is decided by applying that schedule, not by whether a premium feels expensive to you.

What coverage counts toward the mandate?

Creditable coverage under M.G.L. c. 111M, § 1 (opens in a new tab) includes:

• Individual or group health plans that meet MCC, including qualifying employer coverage
• Qualifying student health coverage
• Medicare and MassHealth
• Qualifying military coverage, Indian Health Service coverage and federal employee coverage
• State health-benefit risk pools, qualifying public health plans and Peace Corps coverage
• Qualifying young-adult coverage, including coverage as a named beneficiary on a parent's plan

MCC is the state's minimum standard for a plan's benefits and cost sharing, set out in 956 CMR 5.00 (opens in a new tab). A plan must cover a broad range of services, including doctor visits, hospital care, emergency services, mental-health and substance-use services, and prescription drugs, and the standard also addresses preventive care, deductibles, out-of-pocket limits, benefit caps and drug deductibles.

Some health-related policies do not count. A stand-alone dental or vision plan, disability coverage, accident coverage, workers' compensation, automobile medical payments or a supplemental hospital indemnity policy does not substitute for qualifying health coverage under § 1 (opens in a new tab). A plan can also meet the federal minimum essential coverage definition without meeting Massachusetts MCC, so if you buy coverage outside the Health Connector or from an out-of-state employer, ask whether it meets MCC.

How much is the Massachusetts health insurance penalty?

The 2026 penalty depends on where your income falls against the federal poverty level (FPL). The monthly amounts from TIR 26-1 (opens in a new tab) are:

For a household of one, the 2026 FPL thresholds are $23,475 at 150%, $31,300 at 200%, $39,125 at 250%, $46,950 at 300% and $62,600 at 400%. The thresholds rise with household size, and the 2026 schedule reflects the 2025 federal poverty guidelines, according to TIR 26-1 (opens in a new tab).

The penalty is monthly. You multiply the monthly amount for your income category by the number of penalty months left after the allowable gap adjustment. The amounts are set at half of the lowest-priced applicable ConnectorCare or individual Bronze premium available through the Health Connector as of January 1 of the tax year. For married couples, each spouse's penalty is calculated separately and the two are added together.

The schedule changes each year, so use the table for the tax year you are filing. For tax year 2025, the monthly penalties were $25, $49, $73, $113, $132 and $187 across income bands running from 150.1% to above 500% FPL, according to TIR 25-1 (opens in a new tab). The 2025 bands reflected ConnectorCare eligibility through 500% FPL; for 2026, ConnectorCare eligibility in TIR 26-1 ends at 400% FPL, which is why the top 2026 category starts above 400%.

How long can you go without health insurance in Massachusetts?

No penalty applies to a lapse of 63 consecutive days or less, according to TIR 26-1 (opens in a new tab). For the individual mandate, the Health Connector reads 63 days as three calendar months, so track your coverage by month rather than counting days.

On the tax return, the 2025 Schedule HC instructions (opens in a new tab) treat four or more consecutive months without coverage as the point where a penalty can apply. The worksheet subtracts three months for each qualifying gap, then multiplies the remaining uninsured months by your monthly penalty. If you were uninsured for five months in a row, for example, the calculation would generally count two penalty months.

If your coverage is ending, write down the date it ends, the date the replacement starts, and whether the replacement meets MCC. Those three facts decide the Schedule HC result.

How do Schedule HC and Form MA 1099-HC work?

Schedule HC is filed with Massachusetts Form 1 or Form 1-NR/PY when required. It records whether you, and your spouse if applicable, had qualifying coverage in each month, and the answers determine whether a penalty applies, according to the Department of Revenue (opens in a new tab). Income at or below 150% FPL removes the 2026 penalty, but you may still need to complete Schedule HC if you file a state return.

Form MA 1099-HC is the coverage statement you use to fill out Schedule HC. Private insurers issue it to subscribers, listing the spouse and dependents covered, and MassHealth and the Health Connector issue forms in applicable situations. Forms are generally due by January 31 of the following year, according to the Department of Revenue's carrier reporting guidance (opens in a new tab).

A few situations come up often:

• You changed insurers. You may receive more than one 1099-HC, and each coverage period gets reported.
• Your 1099-HC is missing. For private coverage, use the insurer or administrator name and subscriber number from your insurance card, and contact the insurer for the form. For MassHealth or Health Connector coverage, contact MassHealth or the Health Connector.
• You had Medicare, VA coverage or Tri-Care. These are reported through the matching selection on Schedule HC (opens in a new tab) rather than a 1099-HC.
• You were on a parent's plan. You will need the subscriber and coverage information from that plan.

Part-year residents file Schedule HC with Form 1-NR/PY and report only the months the mandate applied. People who turned 18 during the year are treated the same way: months before the mandate applied do not count as penalty months.

What exemptions and hardship appeals are available?

Several situations can remove or reduce a penalty:

• Income at or below 150% FPL, which produces no 2026 penalty
• Coverage that was unaffordable under the state's affordability and premium schedules
• A coverage lapse of 63 consecutive days or less
• A Massachusetts Certificate of Exemption issued by the Health Connector
• A sincerely held religious belief, claimed through a sworn statement
• A hardship or other circumstance that made affordable coverage unavailable or made the affordability tables unfair in your case

The religious exemption is governed by M.G.L. c. 111M, § 3 (opens in a new tab). You file a sworn affidavit with your state return, and if you claim the exemption but receive medical care during the tax year, you can become liable for the cost of that care and the penalty.

A federal hardship exemption certificate is not the same as a Massachusetts Certificate of Exemption, according to Schedule HC (opens in a new tab), so use the Massachusetts process.

Hardship appeals go through the Health Connector. Hardship categories listed by the Department of Revenue (opens in a new tab) and the Health Connector include changes in income, inability to obtain subsidized coverage, homelessness, risk of eviction or foreclosure, a utility shutoff notice, and a substantial increase in essential expenses. Follow the appeal instructions on the Schedule HC for your tax year.

Where can you get coverage?

You can apply through the Massachusetts Health Connector at MAhealthconnector.org (opens in a new tab), by phone at 1-877-623-6765, or with an enrollment assister. Open enrollment for 2026 coverage ended January 23, 2026, and open enrollment for 2027 coverage begins October 23, 2026, according to the Health Connector (opens in a new tab).

Outside open enrollment, you generally need a Special Enrollment Period tied to a qualifying life event, such as marriage, a birth, loss of other coverage or a permanent move, according to the Health Connector (opens in a new tab). If you lost job-based coverage, ask about the special enrollment deadline and the date your new coverage would start, since that start date determines whether you stay inside the three-month gap.

MassHealth applications are accepted year-round, and some ConnectorCare applicants, including people who newly qualify, can also enroll year-round. For adults ages 19 through 64, MassHealth Standard or CarePlus eligibility uses an income standard near 133% FPL, subject to program category, household, immigration, disability and other rules, according to the 2026 MassHealth income standards (opens in a new tab), effective March 1, 2026. MassHealth or the Health Connector makes the eligibility decision for each applicant.

How do the federal and Massachusetts rules differ?

The federal individual shared responsibility payment was reduced to zero for tax year 2019 and later by the Tax Cuts and Jobs Act, according to the IRS (opens in a new tab). That change applies to your federal return only. Massachusetts kept its own mandate and Schedule HC process, so you can owe nothing federally and still owe a Massachusetts penalty.

Questions to ask an agent or enrollment assister

If someone offers to help you buy coverage, these questions come from NAIC consumer guidance (opens in a new tab) and the Massachusetts Division of Insurance:

• Are you licensed in Massachusetts, and what is your producer license number?
• What is your company's exact legal name, and which insurer issues the policy?
• Is this a Health Connector plan, employer plan, MassHealth program, ConnectorCare plan or something else?
• Does this coverage meet Massachusetts Minimum Creditable Coverage?
• Are my doctors, hospitals and prescriptions included?
• What deductible, copayments, coinsurance and out-of-pocket maximum apply?
• Is there a fee for your service?
• If I am outside open enrollment, what qualifying event supports a Special Enrollment Period?
• How will I receive Form MA 1099-HC?

You can confirm a producer's license through the Division of Insurance license verification service (opens in a new tab) or the Massachusetts insurance license lookup (opens in a new tab). Complaints about an insurer or agent go to the Division's Consumer Services Unit through its complaint process (opens in a new tab). Self-funded employer plans are generally regulated federally, the Division does not regulate MassHealth, Medicare plans or Group Insurance Commission plans, and medical-necessity complaints go to the Office of Patient Protection. Billing problems, claims issues and suspected scams can also be reported to the Attorney General's Health Care Division (opens in a new tab). Riskado's guide on how to choose an insurance agent covers license checks and other questions to ask.

Frequently asked questions

Is the Massachusetts penalty charged for a full year?

No, it is charged by the month. You multiply your income category's monthly amount by the uninsured months left after the three-month gap adjustment, so the 2026 full-year amounts of $312 to $2,532 apply only to a full year without coverage.

Does a parent's health plan count for a young adult?

Yes, if it is qualifying coverage. Creditable coverage includes coverage as a named beneficiary and qualifying young-adult coverage under M.G.L. c. 111M, § 1 (opens in a new tab). You will need the subscriber's information to complete Schedule HC.

Does Medicare satisfy the Massachusetts requirement?

Yes. Medicare is creditable coverage under M.G.L. c. 111M, § 1 (opens in a new tab). It is reported through its own selection on Schedule HC rather than a 1099-HC.

What happens if I claim the religious exemption and then get medical care?

Under M.G.L. c. 111M, § 3 (opens in a new tab), you can become liable for the cost of that medical care and for the penalty for that tax year.

When can I next enroll without a qualifying event?

Open enrollment for 2027 coverage begins October 23, 2026, according to the Health Connector (opens in a new tab). MassHealth applications are accepted year-round.

Getting your coverage and return in order

Start with your coverage months. Gather every Form MA 1099-HC and your insurance cards, mark which months you had MCC-qualifying coverage, and note any gap longer than three months. Then check your income category for the tax year, look at whether an exemption or hardship appeal fits your situation, and, if you need coverage now, contact the Health Connector or MassHealth to find out which enrollment path is open to you.