At-a-Glance: How the Insurance Mandate Affects You

Medically Reviewed by Sarah Goodell on November 30, 2022
Written by WebMD Editorial Contributors
2 min read

Because of the Affordable Care Act, almost everyone in the U.S. needs to buy health insurance. There used to be a federal penalty for not having insurance, but Congress eliminated that beginning in 2019. Several states - including California, Massachusetts, New Jersey, Rhode Island - do have a state penalty for not having insurance, however. 

But what does that mean for you?

Chances are, you won't need to do anything differently. If you're like most Americans, you get health insurance through your workplace and you can keep that coverage.

 

You have several ways to get insurance to be covered.

The law provides financial assistance to help people with low and moderate incomes to better afford health insurance. They may:

  • Qualify for a subsidy, which is money from the U.S. government to help lower your insurance costs; recently passed legislation provides enhanced subsidies to individuals and families below 150% of the federal poverty line which covers the full premium of the “benchmark” silver plan. People over 400% of the poverty line will have their premiums limited to 8.5% of their income. These enhanced subsidies apply for 2023 to 2025.
     
  • Qualify for Medicaid, the state-federal health insurance program for people with low incomes

 

If you're a naturalized citizen or legally immigrated to the U.S., you must buy insurance, although there is no financial penalty for not doing so.
 

If you're not lawfully present in the U.S., the law requiring people to buy insurance does not apply to you.

In most cases, you can keep your current plan and won't need to do anything new. This is true whether you have employer-based insurance, a private plan, or insurance through the Affordable Care Act.

If your employer offers you insurance, it must meet affordability standards (not more than 9.12% of your annual income in 2023). If it doesn't, you may shop for a plan from your state's Marketplace. You might qualify for financial help in the form of lower premiums and/or cost-sharing subsidies.