Only a handful of U.S. states require all residents who can afford it to have health insurance coverage, and three of them are in New England.
Passed in 2010, the Affordable Care Act, also known as Obamacare, mandated health insurance for nearly all Americans, but Congress later repealed the individual mandate penalty in 2017, meaning individuals would no longer be punished financially at the federal level for not having health insurance.
Today, an estimated 26 million people in the U.S. are currently without health insurance coverage.
In 2022, only five states and the District of Columbia require health insurance coverage at the state-level through local versions of individual mandates. In New England, Massachusetts, Vermont and Rhode Island all mandate health insurance for eligible residents − meaning if someone cannot afford health insurance or has experienced a particular hardship, they will not be penalized. New Jersey and California also require all residents be enrolled in a health insurance plan.
The U.S. is in the midst of its annual open enrollment period, when people can enroll in a health insurance plan for the following calendar year. People are encouraged to enroll by Dec. 15 for coverage that starts Jan. 1. The enrollment period runs through Jan. 15, 2023 in most states.
This year's open enrollment is particularly critical, as up to 15 million Americans could lose Medicaid coverage when the COVID-19 federal public health emergency ends, according to the Department of Health and Human Services − in some cases for reasons as simple as not having updated an address or contact information.
Once the emergency concludes, states will begin to reevaluate who is eligible for coverage, something they've been prohibited from doing since 2020 in order to ensure uninterrupted Medicaid coverage for low-income people.
The Biden administration has said it will give states 60 days notice to prepare. The public health emergency must be renewed every 90 days to stay in effect, and right now it's slated to end Jan. 11, 2023. The Centers for Medicaid and Medicare Services is requiring states to develop plans for how they'll handle the unwinding of the emergency.
Between February 2020 and July 2022, Medicaid and Children's Health Insurance Program enrollment grew nationally by more than 26%.
Does Massachusetts require health insurance coverage?
The Massachusetts Health Care Reform Law requires that most residents older than 18 who can afford health insurance have coverage for the entire year, or pay a penalty through their tax returns, according to the state.
The tax penalties can be up $1,908 per year for an individual, or $159 per month.
The penalties add up for each month someone doesn't comply, but people will not be penalized for a lapse in coverage that lasts fewer than three months. Individuals with incomes less or equal to 150% of the federal poverty level are not penalized.
Massachusetts residents must be enrolled in a plan that meets Minimum Creditable Coverage requirements − the minimum level of benefits to be considered adequately insured and avoid financial penalties from the state. The state says most plans meet MCC standards, and insurance companies must put an MCC-compliance notice on their plans to indicate whether it meets the requirements.
Residents can appeal penalties if they've experienced a state-recognized hardship such as eviction, utility shutoff, death or bankruptcy.
Does Rhode Island require health insurance coverage?
Rhode Island's health insurance mandate took effect on Jan. 1, 2020, requiring all residents, except those exempt under the law, to have qualifying health coverage − through an employer, purchased directly from a health insurance carrier, Medicare and Medicaid, or a health plan purchased through HealthSource RI, the state's health exchange.
Rhode Island issues personal income tax penalties for those who fail to enroll in health insurance. The state calculates penalties using a "shared responsibility" worksheet. The fee is calculated either as 2.5% of a person's yearly household income or per person ($695 per adult and an additional $347.50 per child under age 18), whichever amount is higher.
Like Massachusetts, Rhode Island offers hardship exemptions, for which people can apply.
Does Vermont require health insurance coverage?
Vermont's individual health insurance mandate went into effect on Jan. 1, 2020, requiring most residents 18 and older to acquire acceptable health insurance coverage and report it on their state tax return.
But unlike Massachusetts and Rhode Island, it's an individual mandate with no teeth. Vermont does not issue financial penalties for non-compliance. Instead, the state messages to the public that "it is important that every Vermonter is covered," telling residents that health insurance reduces the risk of expensive medical bills; helps to cover medications, visits to providers and hospital care; and helps people stay healthy by paying for yearly check-ups, screenings and immunizations.
Vermont law requires individuals to report on their state income tax return whether they had health coverage for each month of the year.
When is the open enrollment period? How do I get health insurance?
The national open enrollment period began on Nov. 1 and runs through Jan. 15, 2023. For more information, visit healthcare.gov or your state's health insurance marketplace website.
Rhode Island - HealthSourceRI
Massachusetts Health Connector
Vermont Health Connect
New Hampshire federally facilitated health insurance marketplace