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Who must have health insurance

What are individual plans?

If you do not have coverage through an employer, you can buy an individual plan for yourself and your family during open enrollment through HealthCare.gov or directly from an insurance company.

Am I required to have coverage?

Most people must have basic (minimum essential) coverage or pay a penalty.

Who is not required to have health insurance?

  • Individuals and families whose income is low enough that they do not need to file federal income tax returns
  • People who would have to pay more than 8 percent of family income for insurance after taking premium tax credits and employer contributions into account
  • Individuals who have been uninsured for less than three months
  • People who are incarcerated
  • Undocumented immigrants
  • Members of American Indian tribes
  • People who do not obtain coverage because they belong to religious groups that object to insurance coverage, who belong to a health care sharing ministry, or who qualify for a hardship exemption

What happens if I don't have insurance?

Many people who can afford health insurance but decide not to buy it throughout the year will owe penalties when they file their taxes in the spring of the next year.

What are the penalties?

The penalty grows each year as follows:

  • Tax year 2015: The greater of $325 per adult or 2 percent of taxable income above the filing limit.
  • Tax year 2016: The greater of $695 per adult or 2.5 percent of taxable income above the filing limit.
  • After tax year 2016: The tax penalty increases annually based on a cost-of-living adjustment.
  • Children: The penalty for a child is half that of an adult. Only the first two children are counted in calculating the penalty.

What happens if I don't pay the penalty?

  • You can be without coverage for up to three months without triggering the penalty. After that, you pay the penalty for any month that you are not covered.
  • If you are required to pay a penalty but do not, the IRS will send you a notice. If you do not pay the penalty, the IRS can reduce the amount of a future tax refund.

Questions or complaints?

File a complaint online or contact us:

Insurance
888-877-4894 (toll-free)
Email cp.ins@oregon.gov

Financial services
866-814-9710 (toll-free)
Email dcbs.dfcsmail@oregon.gov

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