CA Health Care Mandate
The California Franchise Tax Board (FTB) provides comprehensive information about the state's health care mandate, which requires California residents to have qualifying health insurance coverage, obtain an exemption, or pay a penalty when filing their state tax return. The following information highlights the key points per FTB.
Health Care Coverage Requirement
Since January 1, 2020, all California residents must have qualifying health insurance, claim an exemption, or pay a penalty.
Coverage must include the taxpayer, spouse or domestic partner, and dependents.
Reporting and Forms
Health care coverage for a tax year is reported on the corresponding state tax return (e.g., 2025 coverage is reported on the 2025 return filed in 2026).
Relevant forms include FTB 3853 (Health Coverage Exemptions and Individual Shared Responsibility Penalty) and FTB 3895 (California Health Insurance Marketplace Statement).
How to Get Coverage
Coverage can be obtained through employer-sponsored plans, Covered California, Medicare, Medicaid, or direct purchase from insurers.
Open enrollment runs through January 30, 2026, with special enrollment periods available for qualifying events.
Exemptions
Exemptions may be claimed on the state tax return or processed by Covered California for reasons such as income below the filing threshold, unaffordable coverage, short coverage gaps, certain non-citizens, incarceration, and more.
Some exemptions (e.g., religious conscience, hardship) must be applied for through Covered California.
Financial Help
Financial assistance is available through Covered California based on household size, age, income, and region.
Medi-Cal offers no- and low-cost coverage options.
Penalties for No Coverage
If you do not have coverage and do not qualify for an exemption, you must pay a penalty when filing your state tax return.
The penalty is the higher of a flat amount ($950 per adult, $475 per child for 2025) or 2.5% of gross income above the filing threshold.
Example: A family of 3 with $200,000 income would pay $3,457 (the higher of the flat amount or percentage calculation).
Additional Resources
The page provides links to tools for estimating penalties, applying for exemptions, and finding coverage.
Information is available in Spanish and other languages.
This summary covers the main requirements, options, and consequences related to California's health care mandate as described on the official state webpage.