New Jersey Health Insurance Penalty: The State Coverage Requirement, the Shared Responsibility Payment and Exemptions

Riskado

Dec 25, 2025 · 9 min read · Updated Sep 30, 2026

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A kitchen table with a closed laptop, a calculator and a stack of blank tax forms beside a mug in morning light

Yes, New Jersey still penalizes going without health insurance. Under the New Jersey Health Insurance Market Preservation Act (opens in a new tab), N.J.S.A. 54A:11, you and your dependents must have minimum essential coverage for each month after December 31, 2018, qualify for an exemption, or pay a Shared Responsibility Payment on your New Jersey income tax return. The federal penalty is a separate rule and has been zero since tax year 2019, according to the IRS (opens in a new tab). New Jersey's payment depends on household income, family size, and uncovered months, and it is capped at the statewide average Bronze plan premium. A gap of less than three months may qualify for an exemption.

Key takeaways

State requirementYou and your dependents must have minimum essential coverage for each month after December 31, 2018, qualify for an exemption, or pay a Shared Responsibility Payment on your New Jersey income tax return.
Federal penaltyThe federal penalty is a separate rule and has been zero since tax year 2019.
How it is figuredNew Jersey's payment depends on household income, family size and uncovered months.
The capThe payment is capped at the statewide average Bronze plan premium.
Short gapsA gap of less than three months may qualify for an exemption.

Does New Jersey still have a health insurance mandate?

It does, and it runs through your state tax return. The state requirement applies to each taxpayer who is an applicable individual and to their applicable dependents. If you do not meet it and no exemption applies, you may owe a state Shared Responsibility Payment, according to the New Jersey Division of Taxation (opens in a new tab).

The federal rule is a separate matter. The Tax Cuts and Jobs Act reduced the federal individual Shared Responsibility Payment to zero for tax year 2019 and later, per the IRS (opens in a new tab). That change did not touch New Jersey's law, which set up its own state payment. If you are uninsured, check the New Jersey rule on its own terms.

What counts as minimum essential coverage in New Jersey?

Most mainstream health coverage counts. The Division of Taxation (opens in a new tab) lists these examples:

Employer-sponsored coverage.
Medicare.
Medicaid.
CHIP.
NJ FamilyCare.
Qualifying Marketplace coverage, including plans through Get Covered New Jersey.
Qualifying individual health plans.

Limited-benefit plans, such as dental-only or vision-only coverage, do not satisfy the requirement. You also do not have to buy through Get Covered New Jersey; any qualifying coverage on the list works.

A young adult covered under a parent's qualifying employer, Marketplace, or other minimum essential coverage plan is generally covered for the months that coverage is in force. Report that person in the tax household and month by month, following the Schedule NJ-HCC instructions.

A few blank plastic member cards fanned out on a wooden table beside a pair of reading glasses — Employer, Marketplace, Medicare, Medicaid and NJ FamilyCare coverage all count.

How much is the New Jersey Shared Responsibility Payment?

The payment is not a flat fine. It generally uses your household income, your family size, and the months you went without coverage or an exemption, and it cannot exceed the statewide average annual premium for Bronze health plans, according to the Division of Taxation's Shared Responsibility Payment page (opens in a new tab).

For tax year 2025, the published ranges are:

New Jersey Shared Responsibility Payment, tax year 2025

Hover or tap a row to highlight it.

Tax year 2025 household	Maximum payment
Individual taxpayer	$4,908 (minimum $695)
Two adults and three dependents, income $200,000 or below	$4,500
Two adults and three dependents, income $200,001 to $400,000	$9,500
Two adults and three dependents, income $400,001 or more	$24,540

Source: New Jersey Division of Taxation (opens in a new tab).

Those figures apply to tax year 2025 only. For tax year 2026, use the Division's official SRP calculator (opens in a new tab) and the current NJ-1040 instructions to estimate your amount. The calculator asks for your household, income, and uncovered months, which is the clearest way to see what a gap would actually cost you.

A wall calendar with three months pinned side by side and a pen resting on the desk below — The payment depends on income, family size and uncovered months.

How long can you go without health insurance in New Jersey?

Less than three months, if you want the short-gap exemption. New Jersey treats you as covered for a month if you had qualifying coverage for at least one day in that month, according to the Division's exemptions page (opens in a new tab).

In practice, if your coverage ends and you then go two full months uninsured, your new coverage must begin by the last day of the third month for the short-gap exemption to apply. A gap of three months or longer does not qualify for those months. If you have more than one short gap in the same year, the exemption generally applies only to the first one.

So, if you are between jobs, the practical step is to line up new coverage before the third month ends. A single day of coverage in that month counts.

How the short-gap exemption works

Coverage endsYour qualifying coverage stops.
Two full months uninsuredThe months without coverage count toward the gap.
Third monthNew coverage must begin by the last day of the third month for the short-gap exemption to apply; one day of coverage in that month counts.
Three months or longerA gap of three months or longer does not qualify for those months.

Which exemptions can prevent the payment?

The short gap is only one of several exemption groups the Division of Taxation (opens in a new tab) recognizes:

Income below the filing threshold.
Marketplace coverage that is unaffordable.
Job-based coverage that is unaffordable.
Household income at or below 138% of the federal poverty level.
A short gap in coverage.
Membership in a recognized religious sect.
Eligibility for Indian Health Services.
Incarceration.
U.S. citizens living abroad and certain non-U.S. citizens.
Hardships, including homelessness, eviction or foreclosure, a utility shutoff, domestic violence, the death of a close family member, a disaster, bankruptcy, unpaid medical expenses, increased costs of caring for a family member, an unsuccessful coverage appeal, a medically supported child, or another hardship.

If you are not required to file a New Jersey resident income tax return, you are automatically exempt from the payment. Most other exemptions are claimed through the Division's NJ Insurance Mandate Coverage Exemption Application and reported on Schedule NJ-HCC. Keep any supporting records the exemptions page names with your tax file.

How to report coverage or an exemption on Form NJ-1040

You report coverage, exemptions, and uncovered months on Schedule NJ-HCC, which you attach to Form NJ-1040, according to the 2025 NJ-1040 instructions (opens in a new tab). On the 2025 return, the Shared Responsibility Payment goes on line 53c.

If everyone in your household had coverage all year, you complete the coverage portion of the schedule. If anyone had uncovered months, you list each person and each month, enter exemption codes where they apply, and calculate the payment using Worksheet L or the official calculator.

Forms 1095 from your insurer, employer, or Marketplace document your coverage. Keep them with your return and follow the current NJ-1040 and Schedule NJ-HCC instructions on whether anything must be attached.

Blank tax paperwork sorted into stacked letter trays and clipped bundles on an office desk — Coverage and uncovered months go on Schedule NJ-HCC with the NJ-1040.

New residents and part-year residents

If you lived in New Jersey for only part of the year, you consider only your New Jersey resident months when reporting coverage and exemptions, according to the NJ-1040 instructions (opens in a new tab). The payment calculation then follows the income rules stated in those instructions.

If you just moved to New Jersey and lost your prior coverage, the move may qualify you for a Special Enrollment Period through Get Covered New Jersey, as long as you meet the Marketplace eligibility rules, according to the Get Covered New Jersey FAQ (opens in a new tab). Apply soon after the move so the new coverage starts inside the short-gap window.

Moving boxes stacked in a bright apartment entryway with a laptop open on one of the boxes — A move to New Jersey may qualify you for a Special Enrollment Period.

How to get covered through Get Covered New Jersey or NJ FamilyCare

Get Covered New Jersey (opens in a new tab) is the state's official Marketplace. Open Enrollment for 2026 coverage ran from November 1, 2025 through January 31, 2026. Outside Open Enrollment, you generally need a qualifying life event, such as losing job-based coverage or moving, to enroll through a Special Enrollment Period. NJ FamilyCare accepts enrollment year-round.

State subsidies may be available in 2026 to an individual with income up to $93,900 or a family of four with income up to $192,900, according to the Get Covered New Jersey financial help page (opens in a new tab). One application checks your eligibility for Marketplace financial help and NJ FamilyCare at the same time.

For NJ FamilyCare, adults ages 19 through 64 generally qualify with income at or below 138% of the federal poverty level, which works out to $1,836 a month for one person or $3,795 a month for a family of four in 2026, according to the New Jersey Department of Human Services (opens in a new tab).

Free enrollment help is available from certified enrollment professionals and brokers through Get Covered New Jersey.

2026 income figures for help with coverage

State subsidies, individualMay be available with income up to $93,900.
State subsidies, family of fourMay be available with income up to $192,900.
NJ FamilyCare, one adultIncome at or below 138% of the federal poverty level, $1,836 a month.
NJ FamilyCare, family of fourIncome at or below 138% of the federal poverty level, $3,795 a month.

Check who is helping you, and where to complain

Before you share income or other personal information with anyone selling or enrolling you in coverage, verify their license through the New Jersey Department of Banking and Insurance (opens in a new tab) licensee search. Write down the person's name, company, contact information, and New Jersey license reference number.

Questions worth asking anyone who helps you enroll:

What license do you hold, and what is your New Jersey license reference number?
Are you acting as a producer, broker, navigator, or certified assister?
Which application or program will you use for me?
What documents do you need for income, household size, or a qualifying life event?
When does the new coverage start, and does it begin before my current plan ends?
How will this coverage be documented for Schedule NJ-HCC?
Are there any application, enrollment, or service fees?
Who do I contact if the application or coverage information is wrong?

If something goes wrong, file a complaint with DOBI's Consumer Inquiry and Response Center or call the consumer hotline at 1-800-446-7467. Include the company or agent name, your policy or certificate number if you have one, supporting documents, and a description of the problem, according to DOBI (opens in a new tab).

Riskado's directory lists insurance agencies across New Jersey by city and category if you would rather work with a local, licensed office.

Where the payment money goes

Payments are deposited into the New Jersey Health Insurance Premium Security Fund under N.J.S.A. 54A:11-5, according to the Market Preservation Act (opens in a new tab). If the Commissioner of Banking and Insurance does not establish the reinsurance plan the law describes, the money goes to the Health Care Subsidy Fund, which may support children's health coverage through NJ FamilyCare, subject to the statute's approval process.

New Jersey health insurance penalty FAQ

Does one day of coverage in a month count?

Yes. New Jersey treats you as covered for the whole month if you had qualifying coverage for at least one day, according to the Division of Taxation (opens in a new tab). That rule is why starting new coverage late in a month still helps.

Do I owe the payment if my income is too low to file?

No. If you are not required to file a New Jersey resident income tax return, you are automatically exempt. Income at or below 138% of the federal poverty level is also its own exemption.

What if I had two short gaps in the same year?

The short-gap exemption generally applies only to the first gap. Months in a later gap need another exemption to stay out of the payment.

Is the payment a criminal fine?

No. It is assessed through your New Jersey income tax return, calculated on Schedule NJ-HCC, and entered on the NJ-1040.

Can I enroll after Open Enrollment ends?

Yes, if you have a qualifying life event such as losing job-based coverage or moving to New Jersey. NJ FamilyCare also takes applications year-round.

Your next step

If you are uninsured right now, count the months. Apply through Get Covered New Jersey or NJ FamilyCare before the third month runs out, then keep your coverage records and run the Division of Taxation calculator before you file.

Terms used in this guide

Tap a term to see what it means.

Minimum essential coverage. Qualifying health coverage, such as employer-sponsored coverage, Medicare, Medicaid, CHIP, NJ FamilyCare and qualifying Marketplace or individual plans.