Internal Revenue Code · 26 U.S.C.
§ 5000A. Requirement to maintain minimum essential coverage
Official text, no changes From the Office of the Law Revision Counsel, release point 119-121 (current through Public Law 119-121 (October 9, 2026)). Compare it with the official text at uscode.house.gov (external site).
Cite as 26 U.S.C. § 5000A
At a glance
Read from the text, the source credit and the official notes. Not part of the law.
- Status
- In force
- Added
- March 23, 2010 by Pub. L. 111–148
- Last amended
- July 4, 2025 by Pub. L. 119–21
- Amendments
- 7 dated changes in the source credit
- Length
- 7 subsections · 2,777 words · about 12 min to read
- Defines
- 9 terms
- Cross-references
- cites 11; cited by 7 Code sections and 11 other regulations
- Regulations
- 6 issued under this section
An applicable individual shall for each month beginning after 2013 ensure that the individual, and any dependent of the individual who is an applicable individual, is covered under minimum essential coverage for such month.
If a taxpayer who is an applicable individual, or an applicable individual for whom the taxpayer is liable under paragraph (3), fails to meet the requirement of subsection (a) for 1 or more months, then, except as provided in subsection (e), there is hereby imposed on the taxpayer a penalty with respect to such failures in the amount determined under subsection (c).
Any penalty imposed by this section with respect to any month shall be included with a taxpayer’s return under chapter 1 for the taxable year which includes such month.
Except as provided in subparagraphs (B) and (C), the applicable dollar amount is $0.
If an applicable individual has not attained the age of 18 as of the beginning of a month, the applicable dollar amount with respect to such individual for the month shall be equal to one-half of the applicable dollar amount for the calendar year in which the month occurs.
The family size involved with respect to any taxpayer shall be equal to the number of individuals for whom the taxpayer is allowed a deduction under section 151 (relating to allowance of deduction for personal exemptions) for the taxable year.
The term “applicable individual” means, with respect to any month, an individual other than an individual described in paragraph (2), (3), or (4).
For purposes of this subparagraph, the term “medical health services” does not include routine dental, vision and hearing services, midwifery services, vaccinations, necessary medical services provided to children, services required by law or by a third party, and such other services as the Secretary of Health and Human Services may provide in implementing section 1311(d)(4)(H) of the Patient Protection and Affordable Care Act.
Clause (i)(II) shall apply to an individual for months in a taxable year only if the information provided by the individual under section 1411(b)(5)(A) of such Act includes an attestation that the individual has not received medical health services during the preceding taxable year.
Such term shall not include any individual for any month if such individual is a member of a health care sharing ministry for the month.
Such term shall not include an individual for any month if for the month the individual is not a citizen or national of the United States or an alien lawfully present in the United States.
Such term shall not include an individual for any month if for the month the individual is incarcerated, other than incarceration pending the disposition of charges.
Any applicable individual for any month if the applicable individual’s required contribution (determined on an annual basis) for coverage for the month exceeds 8 percent of such individual’s household income for the taxable year described in section 1412(b)(1)(B) of the Patient Protection and Affordable Care Act. For purposes of applying this subparagraph, the taxpayer’s household income shall be increased by any exclusion from gross income for any portion of the required contribution made through a salary reduction arrangement.
For purposes of subparagraph (B)(i), if an applicable individual is eligible for minimum essential coverage through an employer by reason of a relationship to an employee, the determination under subparagraph (A) shall be made by reference to 11 So in original. Probably should be followed by “the”. required contribution of the employee.
In the case of plan years beginning in any calendar year after 2014, subparagraph (A) shall be applied by substituting for “8 percent” the percentage the Secretary of Health and Human Services determines reflects the excess of the rate of premium growth between the preceding calendar year and 2013 over the rate of income growth for such period.
Any applicable individual for any month during a calendar year if the individual’s household income for the taxable year described in section 1412(b)(1)(B) of the Patient Protection and Affordable Care Act is less than the amount of gross income specified in section 6012(a)(1) with respect to the taxpayer.
Any applicable individual for any month during which the individual is a member of an Indian tribe (as defined in section 45A(c)(6)).
Any month the last day of which occurred during a period in which the applicable individual was not covered by minimum essential coverage for a continuous period of less than 3 months.
Any applicable individual who for any month is determined by the Secretary of Health and Human Services under section 1311(d)(4)(H) to have suffered a hardship with respect to the capability to obtain coverage under a qualified health plan.
Coverage under a health plan offered in the individual market within a State.
Such other health benefits coverage, such as a State health benefits risk pool, as the Secretary of Health and Human Services, in coordination with the Secretary, recognizes for purposes of this subsection.
Any term used in this section which is also used in title I of the Patient Protection and Affordable Care Act shall have the same meaning as when used in such title.
The penalty provided by this section shall be paid upon notice and demand by the Secretary, and except as provided in paragraph (2), shall be assessed and collected in the same manner as an assessable penalty under subchapter B of chapter 68.
In the case of any failure by a taxpayer to timely pay any penalty imposed by this section, such taxpayer shall not be subject to any criminal prosecution or penalty with respect to such failure.
(Added and amended Pub. L. 111–148, title I, § 1501(b), title X, § 10106(b)–(d), Mar. 23, 2010, 124 Stat. 244, 909, 910; Pub. L. 111–152, title I, §§ 1002, 1004(a)(1)(C), (2)(B), Mar. 30, 2010, 124 Stat. 1032, 1034; Pub. L. 111–159, § 2(a), Apr. 26, 2010, 124 Stat. 1123; Pub. L. 111–173, § 1(a), May 27, 2010, 124 Stat. 1215; Pub. L. 115–97, title I, §§ 11002(d)(1)(GG), 11081(a), Dec. 22, 2017, 131 Stat. 2060, 2092; Pub. L. 115–120, div. C, § 3002(g)(2)(A), Jan. 22, 2018, 132 Stat. 35; Pub. L. 115–271, title IV, § 4003(a), Oct. 24, 2018, 132 Stat. 3959; Pub. L. 119–21, title VII, § 71301(d), July 4, 2025, 139 Stat. 322.)
Terms defined here
Where the text says “the term … means”. Select a term to jump to its definition.
- applicable individual § 5000A(d)(1)
- eligible employer-sponsored plan § 5000A(f)(2)
- health care sharing ministry § 5000A(d)(2)(B)(ii)
- household income § 5000A(c)(4)(B)
- medical health services § 5000A(d)(2)(A)(ii)(I)
- minimum essential coverage § 5000A(f)(1)
- minimum essential coverage § 5000A(f)(3)
- modified adjusted gross income § 5000A(c)(4)(C)
- required contribution § 5000A(e)(1)(B)
Regulations under this section
Treasury regulations (26 CFR) issued under § 5000A
- § 1.5000A-0 Table of contents.
- § 1.5000A-1 Maintenance of minimum essential coverage and liability for the shared responsibility payment.
- § 1.5000A-2 Minimum essential coverage.
- § 1.5000A-3 Exempt individuals.
- § 1.5000A-4 Computation of shared responsibility payment.
- § 1.5000A-5 Administration and procedure.
From Carry Forward Learning, not part of the law
Our pages that use this section
IRS notice guide
Cross-references
Computed from the citations in the text of Title 26 and 26 CFR.
This section cites 11 other sections
- § 152 Dependent defined
- § 6012(a)(1) Persons required to make returns of income
- § 151 Allowance of deductions for personal exemptions
- § 1 Tax imposed
- § 911 Citizens or residents of the United States living abroad
- § 1402(g)(1) Definitions
- § 501(c)(3) Exemption from tax on corporations, certain trusts, etc.
- § 36B Refundable credit for coverage under a qualified health plan
- § 45A(c)(6) Indian employment credit
- § 1311 Correction of error
- § 937(a) Residence and source rules involving possessions
Cited by 7 Code sections
- § 36B(c)(2)(B)(i) Refundable credit for coverage under a qualified health plan
- § 106(g) Contributions by employer to accident and health plans
- § 162(m)(6)(C)(i)(II) Trade or business expenses
- § 4980H(a)(1) Shared responsibility for employers regarding health coverage
- § 6055(e) Reporting of health insurance coverage
- § 6056(b)(2)(B) Certain employers required to report on health insurance coverage
- § 9831(d)(4)(B)(iii) General exceptions
Cited in 11 regulations not issued under it
- § 1.36B-1 Premium tax credit definitions.
- § 1.36B-2 Eligibility for premium tax credit.
- § 1.36B-3 Computing the premium assistance credit amount.
- § 1.36B-4 Reconciling the premium tax credit with advance credit payments.
- § 1.36B-5 Information reporting by Exchanges.
- § 1.162-31 The $500,000 deduction limitation for remuneration provided by certain health insurance providers.
- § 1.6055-1 Information reporting for minimum essential coverage.
- § 54.4980H-1 Definitions.
- § 54.9815-1251 Preservation of right to maintain existing coverage.
- § 54.9815-2715 Summary of benefits and coverage and uniform glossary.
- § 301.6056-1 Rules relating to reporting by applicable large employers on health insurance coverage offered under employer-sponsored plans.
Amendment history
From the source credit and the official notes, newest first.
- Amended by Pub. L. 119–21Parts changed in 2025: (d)(3)
- Amended by Pub. L. 115–271Parts changed in 2018: (d)(2)(A) (f)(1)(A)(iii)
- Amended by Pub. L. 115–120
- Amended by Pub. L. 115–97Parts changed in 2017: (c)(2)(B)(iii) (c)(3)(A) (c)(3)(D) (c)(3)(D)(ii)
- Amended by Pub. L. 111–173Parts changed in 2010: (b)(1) (c)(1) (c)(2)(B) (c)(2)(B)(i) (c)(2)(B)(ii) (c)(2)(B)(iii) (c)(3)(A) (c)(3)(B) (c)(3)(D) (c)(4)(B)(i) (c)(4)(C) (c)(4)(D) (d)(2)(A) (e)(1)(C) (e)(2) (f)(1)(A)(iv) (f)(1)(A)(v) (f)(1)(A)(vii)
- Amended by Pub. L. 111–159
- Amended by Pub. L. 111–152
- Added by Pub. L. 111–148
Where it sits in the Code
Official notes
Show the Law Revision Counsel's notes (amendments, effective dates)
Amendment of Subsection (d)(3)
Pub. L. 119–21, title VII, § 71301(d), (e), July 4, 2025, 139 Stat. 322, provided that, applicable to taxable years beginning after Dec. 31, 2026, subsection (d)(3) of this section is amended by striking “an alien lawfully present in the United States” and inserting “an eligible alien (within the meaning of section 36B(e)(2))”. See 2025 Amendment notes below.
Inflation Adjusted Items for Certain Years
For inflation adjustment of certain items in this section, see Revenue Procedures listed in a table under section 1 of this title.
Editorial Notes
References in Text
The Patient Protection and Affordable Care Act and such Act, referred to in subsecs. (d)(2)(A), (e)(1)(A), (2), and (f)(5), are Pub. L. 111–148, Mar. 23, 2010, 124 Stat. 119. Title I of the Act enacted chapter 157 of Title 42, The Public Health and Welfare, and enacted, amended, and transferred numerous other sections and notes in the Code. Sections 1311(d)(4)(H), 1411(b)(5)(A), and 1412(b)(1)(B) of the Act are classified to sections 18031(d)(4)(H), 18081(b)(5)(A), and 18082(b)(1)(B), respectively, of Title 42. For complete classification of this Act to the Code, see Short Title note set out under section 18001 of Title 42 and Tables.
The Social Security Act, referred to in subsec. (f)(1)(A)(i) to (iii), is act Aug. 14, 1935, ch. 531, 49 Stat. 620. Part A of title XVIII of the Act is classified generally to part A (§ 1395c et seq.) of subchapter XVIII of chapter 7 of Title 42, The Public Health and Welfare. Titles XIX and XXI of the Act are classified generally to subchapters XIX (§ 1396 et seq.) and XXI (§ 1397aa et seq.), respectively, of chapter 7 of Title 42. Section 2107(g) of the Act is classified to section 1397gg(g) of Title 42. For complete classification of this Act to the Code, see section 1305 of Title 42 and Tables.
Section 2791 of the Public Health Service Act, referred to in subsec. (f)(2)(A), (3), is classified to section 300gg–91 of Title 42, The Public Health and Welfare.
Amendments
2025—Subsec. (d)(3). Pub. L. 119–21 substituted “an eligible alien (within the meaning of section 36B(e)(2))” for “an alien lawfully present in the United States”.
2018—Subsec. (d)(2)(A). Pub. L. 115–271 amended subpar. (A) generally. Prior to amendment, text read as follows: “Such term shall not include any individual for any month if such individual has in effect an exemption under section 1311(d)(4)(H) of the Patient Protection and Affordable Care Act which certifies that such individual is—
“(i) a member of a recognized religious sect or division thereof which is described in section 1402(g)(1), and
“(ii) an adherent of established tenets or teachings of such sect or division as described in such section.”
Subsec. (f)(1)(A)(iii). Pub. L. 115–120 inserted “or under a qualified CHIP look-alike program (as defined in section 2107(g) of the Social Security Act)” before comma at end.
2017—Subsec. (c)(2)(B)(iii). Pub. L. 115–97, § 11081(a)(1), substituted “Zero percent” for “2.5 percent”.
Subsec. (c)(3)(A). Pub. L. 115–97, § 11081(a)(2)(A), substituted “$0” for “$695”.
Subsec. (c)(3)(D). Pub. L. 115–97, § 11081(a)(2)(B), struck out subpar. (D). Text read as follows: “In the case of any calendar year beginning after 2016, the applicable dollar amount shall be equal to $695, increased by an amount equal to—
“(i) $695, multiplied by
“(ii) the cost-of-living adjustment determined under section 1(f)(3) for the calendar year, determined by substituting ‘calendar year 2015’ for ‘calendar year 2016’ in subparagraph (A)(ii) thereof.
If the amount of any increase under clause (i) is not a multiple of $50, such increase shall be rounded to the next lowest multiple of $50.”
Subsec. (c)(3)(D)(ii). Pub. L. 115–97, § 11002(d)(1)(GG), substituted “for ‘calendar year 2016’ in subparagraph (A)(ii)” for “for ‘calendar year 1992’ in subparagraph (B)”.
2010—Subsec. (b)(1). Pub. L. 111–148, § 10106(b)(1), amended par. (1) generally. Prior to amendment, text read as follows: “If an applicable individual fails to meet the requirement of subsection (a) for 1 or more months during any calendar year beginning after 2013, then, except as provided in subsection (d), there is hereby imposed a penalty with respect to the individual in the amount determined under subsection (c).”
Subsec. (c)(1), (2). Pub. L. 111–148, § 10106(b)(2), amended pars. (1) and (2) generally. Prior to amendment pars. (1) and (2) related to the amount of and dollar limitations on penalty for failure to maintain minimum essential coverage.
Subsec. (c)(2)(B). Pub. L. 111–152, § 1002(a)(1)(A), inserted “the excess of” before “the taxpayer’s household income” and “for the taxable year over the amount of gross income specified in section 6012(a)(1) with respect to the taxpayer” before “for the taxable year” in introductory provisions.
Subsec. (c)(2)(B)(i). Pub. L. 111–152, § 1002(a)(1)(B), substituted “1.0” for “0.5”.
Subsec. (c)(2)(B)(ii). Pub. L. 111–152, § 1002(a)(1)(C), substituted “2.0” for “1.0”.
Subsec. (c)(2)(B)(iii). Pub. L. 111–152, § 1002(a)(1)(D), substituted “2.5” for “2.0”.
Subsec. (c)(3)(A). Pub. L. 111–152, § 1002(a)(2)(A), substituted “$695” for “$750”.
Subsec. (c)(3)(B). Pub. L. 111–152, § 1002(a)(2)(B), substituted “$325” for “$495”.
Pub. L. 111–148, § 10106(b)(3), substituted “$495” for “$350”.
Subsec. (c)(3)(D). Pub. L. 111–152, § 1002(a)(2)(C), substituted “$695” for “$750” in introductory provisions and cl. (i).
Subsec. (c)(4)(B)(i), (ii). Pub. L. 111–152, § 1004(a)(1)(C), substituted “modified adjusted gross” for “modified gross”.
Subsec. (c)(4)(C). Pub. L. 111–152, § 1004(a)(2)(B), amended subpar. (C) generally. Prior to amendment, text read as follows: “The term ‘modified gross income’ means gross income—
“(i) decreased by the amount of any deduction allowable under paragraph (1), (3), (4), or (10) of section 62(a),
“(ii) increased by the amount of interest received or accrued during the taxable year which is exempt from tax imposed by this chapter, and
“(iii) determined without regard to sections 911, 931, and 933.”
Subsec. (c)(4)(D). Pub. L. 111–152, § 1002(b)(1), struck out subpar. (D). Text read as follows:
“(i) In general.—The term ‘poverty line’ has the meaning given that term in section 2110(c)(5) of the Social Security Act (42 U.S.C. 1397jj(c)(5)).
“(ii) Poverty line used.—In the case of any taxable year ending with or within a calendar year, the poverty line used shall be the most recently published poverty line as of the 1st day of such calendar year.”
Subsec. (d)(2)(A). Pub. L. 111–148, § 10106(c), amended subpar. (A) generally. Prior to amendment, text read as follows: “Such term shall not include any individual for any month if such individual has in effect an exemption under section 1311(d)(4)(H) of the Patient Protection and Affordable Care Act which certifies that such individual is a member of a recognized religious sect or division thereof described in section 1402(g)(1) and an adherent of established tenets or teachings of such sect or division as described in such section.”
Subsec. (e)(1)(C). Pub. L. 111–148, § 10106(d), amended subpar. (C) generally. Prior to amendment, text read as follows: “For purposes of subparagraph (B)(i), if an applicable individual is eligible for minimum essential coverage through an employer by reason of a relationship to an employee, the determination shall be made by reference to the affordability of the coverage to the employee.”
Subsec. (e)(2). Pub. L. 111–152, § 1002(b)(2), substituted “below filing threshold” for “under 100 percent of poverty line” in heading and “the amount of gross income specified in section 6012(a)(1) with respect to the taxpayer.” for “100 percent of the poverty line for the size of the family involved (determined in the same manner as under subsection (b)(4)).” in text.
Subsec. (f)(1)(A)(iv). Pub. L. 111–159, § 2(a)(1), added cl. (iv) and struck out former cl. (iv) which read as follows: “the TRICARE for Life program,”.
Subsec. (f)(1)(A)(v). Pub. L. 111–173, § 1(a), amended cl. (v) generally. Prior to amendment, cl. (v) read as follows: “the veteran’s health care program under chapter 17 of title 38, United States Code,”.
Subsec. (f)(1)(A)(vii). Pub. L. 111–159, § 2(a)(2)–(4), added cl. (vii).
Statutory Notes and Related Subsidiaries
Effective Date of 2025 Amendment
Amendment by Pub. L. 119–21, applicable to taxable years beginning after Dec. 31, 2026, see section 71301(e) of Pub. L. 119–21, set out as a note under section 36B of this title.
Effective Date of 2018 Amendment
Pub. L. 115–271, title IV, § 4003(b), Oct. 24, 2018, 132 Stat. 3960, provided that: “The amendment made by subsection (a) [amending this section] shall apply to taxable years beginning after December 31, 2018.”
Pub. L. 115–120, div. C, § 3002(g)(2)(B), Jan. 22, 2018, 132 Stat. 35, provided that: “The amendment made by subparagraph (A) [amending this section] shall apply with respect to taxable years beginning after December 31, 2017.”
Effective Date of 2017 Amendment
Amendment by section 11002(d)(1)(GG) of Pub. L. 115–97 applicable to taxable years beginning after Dec. 31, 2017, see section 11002(e) of Pub. L. 115–97, set out as a note under section 1 of this title.
Pub. L. 115–97, title I, § 11081(b), Dec. 22, 2017, 131 Stat. 2092, provided that: “The amendments made by this section [amending this section] shall apply to months beginning after December 31, 2018.”
Effective Date of 2010 Amendment
Pub. L. 111–173, § 1(b), May 27, 2010, 124 Stat. 1215, provided that: “The amendment made by subsection (a) [amending this section] shall take effect as if included in section 1501(b) of the Patient Protection and Affordable Care Act [Pub. L. 111–148].”
Pub. L. 111–159, § 2(b), Apr. 26, 2010, 124 Stat. 1123, provided that: “The amendments made by this section [amending this section] shall take effect as if included in section 1501(b) of the Patient Protection and Affordable Care Act [Pub. L. 111–148] and shall be executed immediately after the amendments made by such section 1501(b).”
Effective Date
Pub. L. 111–148, title I, § 1501(d), Mar. 23, 2010, 124 Stat. 249, provided that: “The amendments made by this section [enacting this section and section 18091 of Title 42, The Public Health and Welfare] shall apply to taxable years ending after December 31, 2013.”
Construction of 2018 Amendment
Pub. L. 115–271, title IV, § 4003(c), Oct. 24, 2018, 132 Stat. 3960, provided that: “Nothing in the amendment made by subsection (a) [amending this section] shall preempt any State law requiring the provision of medical treatment for children, especially those who are seriously ill.”