Do I have to have health insurance? Is there still a penalty?
No federal penalty since 2019, and none in Texas. Here is what going without actually costs you instead.
There is no federal penalty for going without health insurance. The individual mandate penalty was reduced to zero starting in 2019. Texas has no state penalty of its own, unlike a handful of states that added one.
So legally, no, you are not required to have coverage. The question worth asking is a different one.
What going without actually costs
The penalty was never the real cost. These are.
- A hospital stay is the leading cause of medical debt, and hospital list prices for the uninsured are far higher than the negotiated rates an insurer pays.
- You lose the free preventive care. Screenings that catch things early are covered at no cost on any Marketplace plan.
- Prescription costs at full retail.
- You cannot buy coverage mid year just because you got sick. A diagnosis is not a qualifying event.
That last one is the trap. Going uninsured is not a month to month decision you can reverse when you need to. If you skip open enrollment and get a diagnosis in March, you generally wait until the following January. See what does open a window.
The affordability question, honestly
Plenty of people go without because coverage genuinely feels out of reach. Before concluding that, check the actual number rather than the sticker price.
The premium tax credit changes the math substantially for most households, and many people in this area pay far less than they expect. Older applicants and larger households often get more help than they assume, because the credit is calculated against the cost of coverage rather than income alone.
Checking costs nothing and commits you to nothing. See whether you qualify and what it actually costs.
If you still decide to go without
Do it with your eyes open rather than by default.
- Know where your nearest federally qualified health center is and that they use sliding scale fees.
- Know that every non profit hospital must have a financial assistance policy, and ask for it by name.
- Put the open enrollment dates in your calendar so it stays a choice rather than a thing that happened.
- Reconsider at every life change. A job change, a new baby, a marriage or an income change all open a window.
One exception worth knowing
If you are approaching 65, going without is a different and more expensive decision, because Medicare has permanent late enrollment penalties that never expire. That is a real penalty and it is still very much in force. See the Medicare penalties.
Common follow-up questions
Is there still an Obamacare penalty?
Not federally, since 2019, and not in Texas. A few other states have their own penalty, but Texas is not one of them.
Can I buy coverage when I get sick?
Generally no. Outside open enrollment you need a qualifying life event, and a diagnosis is not one.
Does the Medicare penalty still exist?
Yes. Medicare's late enrollment penalties for Part B and Part D are permanent and are unrelated to the ACA mandate.
Want this looked at properly?
We are an independent agency in McAllen serving Hidalgo, Cameron and Starr counties. No cost to talk it through.
Call (956) 687-3334Read next
ACA Marketplace open enrollment in McAllen: what to know before November
Health and ACA