What is the penalty for employers who don't provide insurance?

Asked by: Marta Little  |  Last update: September 28, 2025
Score: 4.5/5 (54 votes)

A penalty of $2,970 (for 2024) per full-time employee minus the first 30 will be incurred if the employer fails to offer minimum essential coverage to 95 percent of its full-time employees and their dependents, and any full-time employee obtains coverage on the exchange.

What happens if employer doesn't offer health insurance?

If your employer doesn't offer you insurance coverage, you can fill out an application through the Marketplace. You'll find out if you qualify for: A health insurance plan with savings on your monthly premiums and out-of-pocket costs based on your household size and income.

Is it mandatory to have health insurance in NM?

Starting Jan. 1, 2019, that federal tax penalty was reduced to nothing and New Mexico does not impose penalties for going without insurance. If you don't have major medical health insurance, you'll be responsible for major health care costs.

What triggers an ACA penalty?

The IRS issues Letter 5005-A ACA penalty notices to employers that fail to file the applicable ACA Forms 1094-C and 1095-C with the IRS or fail to furnish the 1095-Cs to applicable ACA full-time employees, as required under IRC Sections 6721 and 6722.

What is the employer penalty for not providing health insurance?

The penalty for each month is $4,460 divided by 12, for each full-time employee receiving a premium tax credit that month (up to a maximum of $2,970 divided by 12, times the number of full-time employees (minus up to 30).

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Is there still a penalty for no health insurance?

Exemptions from the requirement to have health insurance

The fee for not having health insurance (sometimes called the "Shared Responsibility Payment" or "mandate”) ended in 2018. This means you no longer pay a tax penalty for not having health coverage.

Did the ACA penalize employers who did not offer health insurance?

1 The ACA does not require employers to provide health coverage, but it does impose employer penalties in the form of a monthly tax on employers that do not provide adequate and affordable health coverage to certain employees. This is known as the employer “shared responsibility” provision.

How is ACA penalty calculated for employers?

For example, an employer with 100 FTEs offers coverage that meets the minimum essential coverage requirements but 10 employees pay more than 9.5 percent of their W-2 wages (safe harbor) – AND the employees obtain a subsidy for coverage in the California Exchange – then the employer would pay a fine for each employee ...

What is the employer mandate for health insurance?

Employer mandate overview

Employers must offer health insurance that is affordable and provides minimum value to 95% of their full-time employees and their children up to the end of the month in which they turn age 26, or be subject to penalties. This is known as the employer mandate.

What states is it illegal to not have health insurance?

Presently there are six states with individual mandates:
  • California.
  • D.C.
  • Massachusetts.
  • New Jersey.
  • Rhode Island.
  • Vermont (but there's currently no financial penalty attached to the mandate)

Do I have to get insurance through my employer?

The short answer is no, you don't have to enroll in your employer's health insurance coverage. That said, if job-based health insurance is offered and affordable, it is usually a good option to cover your family's medical needs.

Can you get Medicaid if your employer doesn't offer health insurance?

Medicaid and other income-sensitive options

Jobs without coverage usually don't come with huge salaries. Managing your money on a limited income takes some planning, but it doesn't mean you have to go without insurance. You might qualify for Medicaid, the low-income health insurance program.

What is the ACA 30 hour rule?

If an employee is credited with an average of 30 hours per week or more during the Standard Measurement Period, the employee would be eligible for benefits for the upcoming plan year.

How many employers don t offer health insurance?

Small firms' (those with fewer than 50 employees) share of employees working where health insurance was offered was much lower (51.2%) than the national average for firms of all sizes (86%).

Can I refuse health insurance from my employer and get Obamacare?

Obamacare is available to everyone, whether or not their employers offer insurance. From a practical standpoint, though, there are financial consequences to doing this. Often, an employer subsidizes part or all of their employees' coverage.

What is the penalty for employer not offering health insurance?

A penalty of $2,970 (for 2024) per full-time employee minus the first 30 will be incurred if the employer fails to offer minimum essential coverage to 95 percent of its full-time employees and their dependents, and any full-time employee obtains coverage on the exchange.

What is the ACA penalty for employers in 2024?

The 4980H(a) penalty for 2024 is $247.50, or $2,970 annualized, per employee. This is a modest increase from the 2023 figures, which were $240 monthly and $2,880 annualized.

What employers are exempt from ACA?

Small business owners with fewer than 50 full-time employees are not required to offer health care coverage to their employees. However, you should know that if a small business with fewer than 50 full-time employees does offer coverage, then that coverage must comply with the requirements of the ACA.

Can I sue my employer for not providing health insurance?

It has an obligation to honor that commitment, even though the law does not require it to provide health insurance. Otherwise, an employee can sue the employer to enforce the contract.

Did ACA make health insurance mandatory?

One of the most controversial aspects of the Affordable Care Act was the individual mandate. The mandate aimed to encourage people in the U.S. to maintain health insurance coverage. This meant that most people who were not signed up for health insurance faced a financial penalty.

Can I get ACA instead of employer insurance?

If you decline individual health insurance through your employer, you can enroll in an Obamacare plan through the Marketplace.

Is it illegal to not be on health insurance?

New Jersey, California, Rhode Island, Massachusetts, and the District of Columbia require their residents to have health insurance coverage or face penalties. Vermont recommends that residents have coverage, but there's no noncompliance penalty.

Does the IRS still require proof of health insurance?

Health care coverage documents

You are not required to send the IRS information forms or other proof of health care coverage when filing your tax return. However, it's a good idea to keep these records on hand. This documentation includes: Form 1095 information forms.

Is the Affordable Care Act still in effect?

Together with the Health Care and Education Reconciliation Act of 2010 amendment, it represents the U.S. healthcare system's most significant regulatory overhaul and expansion of coverage since the enactment of Medicare and Medicaid in 1965. Most of the act's provisions are still in effect.