Insure Health Plans · Updated July 2026
Under the California health insurance mandate, in effect since January 2020, every adult and child in the state must carry medical coverage that complies with the Affordable Care Act (ACA). Despite the goal of insuring 100% of the California populace, exemptions exist for a variety of reasons.
Ideally, everyone has coverage to help pay for healthcare-related expenses. If you or anyone in your family does not currently have qualifying coverage through an employer, a private plan, or a government program like Medicare or Medi-Cal, you can avoid penalties by enrolling in a plan or confirming you qualify for an exemption. A good place to start is reviewing the private health insurance options available in your area.
Key Takeaways
California enforces its mandate through the state income tax return. For the 2025 tax year (returns filed in 2026), the Individual Shared Responsibility Penalty is at least $950 per uninsured adult and $475 per uninsured child — or 2.5% of household income above the state filing threshold, whichever is greater. A family of four that goes uninsured all year could owe $2,800 or more. Unless you fit one of the exemption categories below, carrying qualifying coverage is almost always the better financial decision.
California has a minimum income threshold for filing a state tax return. If your household income falls below that threshold and you are not required to file, you are not subject to the mandate penalty either. The thresholds vary by filing status, age, and number of dependents, so check the current figures with the Franchise Tax Board for your specific situation.
Many low-income individuals and families get help through programs like Medi-Cal, but others fall in between — earning too much to qualify for assistance yet still finding coverage out of reach. If the lowest-cost plan available to you costs more than a set percentage of your household income (a figure adjusted annually by the state), coverage is considered unaffordable and you may claim an exemption. This applies to both private plans and employer-sponsored coverage.
If you are between jobs or otherwise without health insurance for less than three consecutive months, you will not face a penalty for that short gap under California law.
Some religious groups hold legal conscientious objections to modern healthcare that exempt their members from the mandate. In addition, individuals and families enrolled in a recognized healthcare sharing ministry — in which members share medical expenses for treatments accepted by their belief system — are likewise exempt.
Anyone currently incarcerated after final sentencing is not bound by the mandate. In these instances, healthcare is provided by the correctional system itself.
The rules surrounding undocumented immigrants and temporary non-citizens residing in California are more complex, but the mandate does provide exemptions for people in these situations.
Members of tribes recognized by the U.S. federal government, including Alaska Native populations, are not required to carry standard health insurance — provided they are eligible for care through the Indian Health Service or tribe-specific healthcare providers.
California residents who live in another state or country during the year are not required to maintain state-approved coverage. Likewise, people temporarily living in California who are legal residents of another state are exempt from the mandate.
The goal of the California health insurance mandate is to help every resident afford medical care when they need it. If none of the exemptions above applies to you, the smart move is to get covered before tax time. Depending on your needs and budget, that might mean an ACA marketplace plan, or it might mean comparing private medical PPO health insurance plans that give you a broader choice of doctors and hospitals.
Ready to explore your options? Browse private health insurance options from top-rated carriers, compare PPO and EPO medical plans side by side, or speak with a licensed advisor today at (800) 939-3330. There is never a fee for our help.
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