What If You Don’t Have Health Coverage in 2016


If you can afford health insurance but don’t have coverage in 2016, you may have to pay a fee in addition to all of your health care costs.

The fee in 2016

The fee for not having health coverage is calculated one of two ways. If you or your dependents don’t have insurance that qualifies as minimum essential coverage you'll pay either a percentage of your household income or a flat fee -- whichever is higher.

  • 2.5% of your yearly household income. (Only the amount of income above the tax filing threshold, about $10,150 for an individual, is used to calculate the penalty.) The maximum penalty is the national average premium for a bronze plan.
  • $695 per person for the year ($347.50 per child under 18). The maximum penalty per family using this method is $2085.

Minimum essential coverage

To avoid the fee in 2016 you need insurance that qualifies as minimum essential coverage. If you're covered by any of the following, you're considered covered and don't have to pay a penalty:

  • Any Marketplace plan, or any individual insurance plan you already have
  • Any employer plan (including COBRA), with or without “grandfathered” status. This includes retiree plans
  • Medicare
  • Medicaid
  • The Children's Health Insurance Program (CHIP)
  • TRICARE (for veterans and veteran families)
  • Veterans health care programs (including the Veterans Health Care Program, VA Civilian Health and Medical Program (CHAMPVA), and Spina Bifida Health Care Benefits Program)
  • Peace Corps Volunteer plans

Other plans may also qualify. Give us a call to help to determine if you have the right coverage.


This is a summary of certain aspects of the Affordable Care Act, current as of October 20, 2015. You can view the original source for this summary at https://www.healthcare.gov/fees-exemptions/fee-for-not-being-covered/ or contact us for a printed copy.

Attention: This website is operated by Benefinder and is not the Health Insurance Marketplace website. In offering this website, Benefinder is required to comply with all applicable federal laws, including the standards established under 45 CFR 155.220(c) and (d) and standards established under 45 CFR 155.260 to protect the privacy and security of personally identifiable information. This website may not display all data on Qualified Health Plans being offered in your state through the Health Insurance Marketplace website. To see all available data on Qualified Health Plan options in your state, go to the Health Insurance Marketplace website at HealthCare.gov.”

Also you should visit the Health Insurance Marketplace website at HealthCare.gov if:

  • You want to select a catastrophic health plan.
  • You want to enroll members of your household in separate Qualified Health Plans.
  • The plans offered here don’t offer pediatric dental coverage and you want to choose a Qualified Health Plan that covers pediatric dental services or a separate dental plan with pediatric coverage. Pediatric dental services are an essential health benefit.