The Requirement to Have Health Insurance 2017-11-01T01:34:21+00:00

The Requirement to Have Health Insurance

Most people are required to have health insurance or pay a penalty if they don’t. Coverage can include employer-provided insurance, coverage you buy on your own, Medicare, TRICARE, Medicaid, and FAMIS.

The fee for not having health insurance in 2016 & 2017

The fee is calculated 2 different ways – as a percentage of your household income, and per person. You’ll pay whichever is higher. The fee rises with inflation. Final 2018 amounts will be published when available.

Percentage of household income

  • 2.5% of household income
  • Maximum: Total yearly premium for the national average price of a Bronze plan sold through the Marketplace

Per person

  • $695 per adult
  • $347.50 per child under 18
  • Maximum: $2,085

Several groups are exempt from the requirement to obtain coverage or pay the penalty, including:

  • People who would have to pay more than 8 percent of their income for health insurance.
  • People who fall into Virginia’s “Medicaid Gap” because the state has not expanded its Medicaid program to cover more low income adults.
  • People with incomes below the threshold required for filing taxes.
  • People who qualify for religious exemptions.
  • Undocumented immigrants.
  • People who are incarcerated.
  • Members of Native American tribes.

If you do not have insurance and do not fit into one of these categories, then you will likely pay a penalty. Learn more about the individual shared responsibility payment from the Internal Revenue Service.