Penalty for Not Having Health Insurance

Starting in 2019, it is not required to have health insurance. If you do not have health insurance in 2018, you may have to pay a penalty. There are some exceptions to this (see below).

Do I have to have health insurance?

If you don’t have insurance in 2018, you may pay a penalty. You don’t have to pay a penalty if:

  • You are part of a federally recognized religion that prevents you from accepting insurance , such as Amish.
  • You are a member of a recognized health care sharing ministry.
  • You are a member of a recognized American Indian tribe.
  • You are an undocumented immigrant.
  • You are in jail or prison.
  • You are not required to file federal income tax because your income is below the filing level. For 2017, individuals under age 65 did not have to file taxes if they earned less than $10,400. For a married couple under age 65 filing taxes together, this was income below $20,800.
  • You do not have an health insurance option available. This means:
    • Health insurance would cost more than 8% of your income.
    • You would have qualified for if Missouri had chosen to increase eligibility. The expansion would have covered individuals with income below $16,394 and a family of four with income below $33,534.

How much do I have to pay if I do not have health insurance?

If you do not have health insurance in 2018, you may pay the penalty when you file your federal income taxes in 2019 (unless you are exempt – see list above). The penalty will be the larger amount of either a flat rate or a percentage of income (or the money you make in a year). The exact amount will depend on family size. Penalty is the larger amount of:

  • 2.5% of income
  • $695 per adult
  • $347.50 per child
  • (Up to $2,085 for a family)

How do I pay the penalty?

The Internal Revenue Service (IRS) will collect the penalty by asking you to show proof of health insurance when you file your federal income taxes. If you do have to pay a penalty, the amount will be taken out of any tax refund you are owed.

Benefits

Benefits are the health care services and items covered under a health insurance plan. Benefits vary based on your specific health insurance plan. Under the health law, essential health benefits are a set of benefits new health plans sold to individuals and families must cover.

Affordable and minimum value coverage

Employers who offer insurance may be subject to penalties if the coverage they offer is not considered affordable or does not provide a minimum level of coverage. To be considered affordable coverage, a worker’s share of premiums should be less than 9.5% of their pay. For example, if a worker is paid $35,000 a year, his or her share of premiums for individual coverage should be less than $3,325 for the year.

For coverage to meet the minimum value requirement, it should have an actuarial value of 60%. For example, if a covered health service costs $100, the health plan would pay $60 and the worker would be responsible for paying $40.

Medicaid

A government health insurance program for Americans who have low incomes or disabilities. In Missouri, this program is called “MO HealthNet” for adults, and “MO HealthNet for Kids” for children up to age 19.