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13 qualifying life events that trigger ACA special enrollment
Outside of open enrollment, a special enrollment period allows you to enroll in an ACA-compliant plan (on or off-exchange) if you experience a qualifying life event.

Latest News & Topics

Latest News & Topics


Finalized federal rule reduces total duration of short-term health plans to 4 months
A finalized federal rule will impose new nationwide duration limits on short-term limited duration insurance (STLDI) plans. The rule – which applies to plans sold or issued on or after September 1, 2024 – will limit STLDI plans to three-month terms, and to total duration – including renewals – of no more than four months.
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individual mandate

What is the individual mandate?

What is the individual mandate?

The individual mandate is a provision within the Affordable Care Act that required individuals to purchase minimum essential coverage – or face a tax penalty – unless they were eligible for an exemption.

Who was affected by the individual mandate?

Most Americans already get health insurance either from an employer or from the government (Medicaid, Medicare, VA), so they didn’t need to worry about the penalty (because employer-sponsored and government-sponsored health insurance count as minimum essential coverage).

How big were Obamacare penalties?

The IRS reported that for tax filers subject to the penalty in 2014, the average penalty amount was around $210. In 2015, the average penalty was around $470. On 2016 tax returns, the average was about $667 per filer who owed a penalty.

For 2018, the penalty for a middle-income family of four earning $60,000 was $2,085.

The penalty could never exceed the national average cost for a Bronze plan, though – as penalty caps were readjusted annually to reflect changes in the average cost of a Bronze plan.

Is the individual mandate still in effect?

Technically, the individual mandate itself is still in effect, but there’s no longer a penalty to enforce it. The tax penalty was eliminated after the end of 2018, under the terms of the Tax Cuts and Jobs Act of 2017.

The continued existence of the mandate – but without the penalty –  is the crux of the California v. Texas (aka Texas v. Azar) lawsuit, in which 20 states challenged the constitutionality of the mandate without the penalty, arguing that the entire ACA should be overturned if the mandate is unconstitutional.

That case ultimately was argued before the Supreme Court in late 2020, but a ruling is not expected until June 2021.

What was the basis for including an individual mandate?

When the Affordable Care Act was written, lawmakers knew that it would be essential to get healthy people enrolled in coverage, since insurance only works if there are enough low-cost enrollees to balance out the sicker, higher-cost enrollees. So the law included an individual mandate, otherwise known as the shared responsibility provision.

Do states have their own individual mandates?

Yes. Although the federal individual mandate penalty was eliminated at the end of 2018, some states have implemented their own individual mandates and associated penalties.

Which states have individual mandates?

Mandates are in effect in Massachusetts, New Jersey, the District of Columbia, California  and Rhode Island.

Related articles

Federal penalties for being uninsured no longer apply since 2019, but some states are implementing their own coverage mandates

The ACA's individual mandate penalty was assessed for the last time on tax returns filed in 2019; there's no longer a federal penalty for being uninsured, but some states have their own mandates and penalties.
The end of ACA's individual mandate penalty means exemptions are unnecessary – unless you're in one of a growing number of states with a coverage mandate.
Businesses with 50 or more full-time equivalent (FTE) employees are required to offer comprehensive, affordable health insurance coverage or they risk a penalty.
The individual mandate still exists. But starting with the 2019 tax year, there is no longer a penalty for non-compliance with the individual mandate.