26 U.S.C. § 5000A — Requirement to maintain minimum essential coverage

(a) Starting with any month after 2013, every "applicable individual" (defined in (d)) must make sure that they, and any of their dependents who are also applicable individuals, have "minimum essential coverage" (defined in (f)) for that month. (b) Shared responsibility payment: (1) If a taxpayer — or someone the taxpayer is responsible for under (b)(3) — fails to meet the coverage requirement for one or more months, the taxpayer owes a penalty for those months, in the amount (c) sets, unless (e) exempts them. (2) The penalty goes on the taxpayer's regular income tax return for that year. (3) Who pays: (A) if the uncovered person is someone else's dependent, that other taxpayer is liable for the penalty; (B) if the uncovered person files a joint return, both spouses are jointly liable. (c) Penalty amount: (1) It equals the smaller of (A) adding up the monthly penalty amounts from (2) for every month in the year that had a failure, or (B) the national average price of a bronze-level marketplace plan sized for the taxpayer's family. (2) Each month's penalty is 1/12 of whichever is greater: (A) a flat dollar amount — the smaller of (i) adding each uncovered person's individual dollar amount under (3), or (ii) 300% of one person's dollar amount; or (B) a percentage of income — a set percentage (1.0% for 2014, 2.0% for 2015, 0% after 2015) of the amount by which the household's income for the year exceeds the income level at which someone must file a tax return. (3) The "applicable dollar amount": (A) is normally $0; (B) but is $95 for 2014 and $325 for 2015; (C) for anyone under 18 at the start of the month, it is cut to half the amount that would otherwise apply. (4) Income and family definitions: (A) family size equals the number of people the taxpayer claims a personal exemption for that year; (B) household income is the taxpayer's modified adjusted gross income plus the modified adjusted gross income of every other person counted in that family size who also had to file their own tax return; (C) modified adjusted gross income is adjusted gross income plus any foreign-earned income excluded under section 911, plus any tax-exempt interest received or accrued that year. (d) Who counts as an "applicable individual": (1) Anyone, for a given month, except someone described in (2), (3), or (4). (2) Religious exemptions: (A)(i) does not include someone with an in-effect exemption certifying either (I) they belong to a recognized religious sect (as section 1402(g)(1) describes) that follows established teachings, or (II) they belong to a different religious sect that relies solely on religious healing, for whom accepting medical care would conflict with their beliefs. (ii) Special rules: (I) "medical health services" here excludes routine dental, vision, and hearing care, midwifery services, vaccines, medical services required for children, services required by law or a third party, and anything else HHS specifies; (II) the (I)(II) exemption applies for a taxable year's months only if the individual attests they received no medical health services during the previous taxable year. (B)(i) does not include a member of a "health care sharing ministry" for that month. (ii) A "health care sharing ministry" is an organization that (I) is a tax-exempt 501(c)(3); (II) whose members share a common set of ethical or religious beliefs and share medical costs according to those beliefs, regardless of what state a member lives or works in; (III) whose members keep their membership even after developing a medical condition; (IV) that (or a predecessor) has existed continuously since before December 31, 1999, with continuous cost-sharing since at least that date; and (V) that undergoes an independent certified public accountant's annual audit, made available to the public on request. (3) Does not include someone who, for the month, is not a U.S. citizen, national, or lawfully present alien. (4) Does not include someone incarcerated for the month, unless they are only being held pending resolution of charges. (e) No penalty applies to: (1) People who cannot afford coverage — (A) any applicable individual for a month where their required contribution (figured yearly) for coverage exceeds 8% of their household income, with household income increased to reflect any pretax salary-reduction contribution; (B) "required contribution" means (i) for someone eligible for employer-sponsored coverage, the self-only-coverage premium share they would pay, whether through salary reduction or otherwise, or (ii) for someone eligible only for individual-market coverage, the annual premium of the cheapest bronze plan available through their local Exchange, minus the premium tax credit they would get under section 36B if covered by an Exchange plan all year; (C) for someone eligible for coverage through a relative who is an employee, the calculation uses that employee's required contribution; (D) for plan years after 2014, the 8% threshold is adjusted by substituting the percentage HHS calculates reflects how much faster premiums grew than income since 2013. (2) Any applicable individual for a month during a year where their household income is below the income level requiring a tax return. (3) Any applicable individual for a month they belong to an Indian tribe, as section 45A(c)(6) defines it. (4) Short coverage gaps: (A) any month whose last day fell within a continuous period of under 3 months without minimum essential coverage. (B) Special rules: (i) the length of that period is counted without regard to calendar-year boundaries; (ii) if a gap runs longer than 3 months, no month within it gets this exemption; (iii) if more than one qualifying gap occurs in a calendar year, only months in the first gap get the exemption — and the Secretary must set rules for gaps that span more than one taxable year. (5) Any applicable individual HHS determines suffered a hardship affecting their ability to get coverage under a qualified health plan. (f) "Minimum essential coverage" means: (1) coverage under (A) government programs — Medicare Part A, Medicaid, CHIP (or a qualified CHIP look-alike program), TRICARE and related military medical coverage, a VA health care program, a Peace Corps volunteer health plan, or the Defense Department's Nonappropriated Fund Health Benefits Program; (B) an eligible employer-sponsored plan; (C) a health plan offered in a state's individual market; (D) a grandfathered health plan; or (E) other health coverage HHS recognizes for this purpose, such as a state health-benefits risk pool. (2) "Eligible employer-sponsored plan" means, for an employee, a group health plan or group coverage from an employer that is (A) a governmental plan, or (B) any other plan or coverage offered in a state's small- or large-group market — and includes a grandfathered group plan. (3) "Minimum essential coverage" does not include coverage that is only "excepted benefits," as specifically defined under the Public Health Service Act, whether under one listed category or, for certain others, when provided as a separate policy. (4) An applicable individual is treated as having minimum essential coverage for a month if (A) that month falls within a period covered by the foreign-earned-income exclusion's residency rules, or (B) they are a bona fide resident of a U.S. possession that month, as section 937(a) determines. (5) Any insurance-related term also used in Title I of the Patient Protection and Affordable Care Act has the same meaning here as it has there. (g) Administration: (1) The penalty is paid after notice and demand by the Secretary and, except as (2) provides, is assessed and collected like other assessable penalties under subchapter B of chapter 68. (2) Special rules: (A) failing to pay this penalty on time does not expose the taxpayer to criminal prosecution or penalty; (B) the Secretary cannot file a lien against a taxpayer's property, or levy on it, just because of an unpaid penalty under this section.

The source credit shows that this section was added by Public Law 111–148, title I, § 1501(b), and title X, § 10106(b)–(d), enacted March 23, 2010, and published at 124 Stat. 244, 909–910. The record further indicates that the section has since been amended repeatedly — by Public Law 111–152 (2010), Public Law 111–159 (2010), Public Law 111–173 (2010), Public Law 115–97 (2017), Public Law 115–120 (2018), Public Law 115–271 (2018), and most recently Public Law 119–21 (2025) — reflecting sustained legislative attention to this provision over more than a decade. Public Law 111–148 is widely known as the Patient Protection and Affordable Care Act (ACA), the major 2010 statute restructuring aspects of the American health insurance system. The individual mandate and associated shared-responsibility payment established in this section are commonly understood to have been designed to encourage broad participation in health insurance markets, on the premise that widespread enrollment—including by healthier individuals—was necessary to stabilize insurance risk pools alongside the Act's other market reforms, such as guaranteed issue and prohibitions on medical underwriting. The later amendments, including the 2017 change reducing the associated penalty amount, are consistent with subsequent congressional and executive branch reconsideration of the mandate's design and enforcement. However, the specific legislative intent behind each individual amendment listed in the source credit is not established by the record provided, and no further characterization of those enactments' particular purposes should be inferred beyond what is stated here.