D.C. Individual Mandate 2021
Learn whether you must have health coverage under the Affordable Care Act (Obamacare) in District of Columbia.
Do I Have to Get Health Insurance in the District of Columbia?
Updated: 2020-07-28 by
D.C. law requires you to have health insurance.
Unless you qualify for an exemption, you may be required to pay a tax penalty if you go without health insurance in the District of Columbia. Even though the federal tax penalty for going without health insurance went away in January 2019, the District of Columbia passed its own law imposing a state tax penalty for people who live in D.C.
The penalty is $695 per adult (half that amount for a child) with a maximum penalty of $2,085 or 2.5% of household income, whichever is greater. For the percentage of income calculation, the cap is the average annual premium cost for a bronze plan purchased at DC Health Link.
To avoid the D.C. tax penalty, you must have what the District considers "minimum essential coverage" or prove your eligibility for an exemption.
What qualifies as minimum essential coverage in D.C?
If you have any of the following types of health coverage, you won’t have to pay a penalty:
- an individual insurance plan that meets the requirements of the Affordable Care Act, whether purchased on your own or through DC Health Link, the exchange serving the District of Columbia
- a plan (including COBRA or a retiree plan) provided by your employer
- Medicare, Medicaid, or coverage under the Children’s Health Insurance Program (CHIP) or the Immigrant Children's Program
- TRICARE (coverage from the U.S. military)
- coverage under a veterans health care program
- coverage through the Peace Corps
- health coverage provided under a "multiple employer welfare arrangement" if the arrangements meets laws that were in place as of December 15, 2017.
If you aren’t sure whether your current plan qualifies, talk to the plan provider.
What doesn't qualify as minimum essential coverage?
Some types of health plans don’t meet the requirements for coverage under the Affordable Care Act. These include vision insurance, dental insurance, workers’ compensation, coverage that is limited to a specific condition, and plans that offer only discounted medical services.
Am I exempt from the D.C. health insurance requirement?
When the District of Columbia adopted its health insurance requirement, it carried over all the coverage exemptions that originally existed in the Affordable Care Act. It also added a few rules of its own. Under these rules, you don't have to pay the penalty if:
- You qualify for Medicaid.
- Your income is low enough that you don't have to file a D.C. tax return.
- You lack coverage for fewer than three consecutive months of the year.
- You weren't a D.C. resident for the months you weren't covered.
- You have D.C. Healthcare Alliance coverage.
- You are a U.S. citizen who lived abroad during the tax year.
- You are not a legal U.S. resident.
- You are a member of a health care sharing ministry.
- You are a member of a religious group that is conscientiously opposed to accepting health care benefits, including Social Security and Medicare.
- You refuse coverage because of a sincerely held religious belief.
- You are a member of a federally recognized Indian tribe.
- You are in jail or serving a prison sentence.
If you were unable to pay for coverage due to financial or personal hardship, you may apply for an exemption through D.C. Health Link. Hardship exemptions may cover situations from homelessness to domestic violence to bankruptcy.
D.C. Health Link offers a tool to help you understand the health insurance requirement, including whether or not you are exempt from the law and how to apply for a hardship exemption.
To find out how to obtain coverage, see How to Sign Up for Obamacare in the District of Columbia.
For information about costs, see How Much Does Obamacare Cost in the District of Columbia?
You may also be interested in:
Where to go in District of Columbia to get health plans under the Affordable Care Act (Obamacare) and how to get help with the application process.
Essential facts about the Affordable Care Act (ACA or Obamacare) in District of Columbia, including whether you must get health insurance, how much it will cost, and how you can save money.
The Affordable Care Act (Obamacare) tax penalty has been set to zero, but some states have enacted their own health insurance requirements.