Do I have to have health insurance? Is there still a penalty?

No federal penalty since 2019, and none in Texas. Here is what going without actually costs you instead.

Updated September 3, 2026 · 3 min read · by Gerino Alejos

Key points

There is no federal penalty for going without health insurance, because the fine was reduced to zero starting in 2019, and Texas has no penalty of its own.
You cannot buy coverage in the middle of the year just because you got sick. A diagnosis is not one of the life changes that opens a signup window.
If you are close to 65, going without costs you more, because Medicare has late enrollment penalties that never expire.

No. There is no federal penalty for going without health insurance. The individual mandate penalty, the fine the law used to charge, was reduced to zero starting in 2019. Texas has no state penalty of its own, unlike a handful of states that added one.

So no, you are not required by law to have coverage. Going without still has a cost, and it does not show up as a fine.

What going without actually costs

Even with the fine gone, going without costs you money in four ways.

A hospital stay is the leading cause of medical debt. Hospitals charge people without insurance the full list price, which runs far higher than the rate an insurance company has worked out with them.
You lose preventive care at no extra charge. Screenings that catch a problem early are covered on any Marketplace plan, the coverage you buy for yourself through the government website.
Your prescriptions cost full retail.
You cannot buy coverage in the middle of the year just because you got sick. A diagnosis is not a qualifying life event, one of the changes that lets you sign up outside the yearly window.

Going without is not a month to month choice you can undo the day you need it. Open enrollment is the yearly window when anyone can sign up. If you skip it and a diagnosis comes in March, you generally wait until the following January. See what does open a window.

The affordability question

Plenty of people go without because coverage feels out of reach. Before you settle on that, find out what you would pay, not what the plan costs on paper.

Your premium is the monthly bill for the coverage. The premium tax credit is money from the government that lowers that bill. For most households it changes the math, and many people in this area pay far less than they expect.

Older applicants and larger households often get more help than they expect. The help is figured from what the coverage costs, not from your income alone.

Checking costs nothing and commits you to nothing. See whether you qualify and what it actually costs.

If you still decide to go without

Then go in prepared.

Find your nearest federally qualified health center, a community clinic, and ask about sliding scale fees, which are set by what you earn.
Know that every non profit hospital must have a financial assistance policy, and ask for it by name.
Put the open enrollment dates on your calendar, so going without stays a choice you make each year.
Look at this again at every life change. A job change, a new baby, a marriage or an income change all open a window.

One exception worth knowing

If you are coming up on 65, going without is a different and more costly decision. Medicare has late enrollment penalties that are permanent and never expire. Those penalties are real, and they are still in force. See the Medicare penalties.

Before you decide either way, get a price for your household and check whether the tax credit lowers it. Call our McAllen office at (956) 687 3334, or use the ZIP form on this page.

Common follow-up questions

Is there still an Obamacare penalty?

Not federally, since 2019, and not in Texas. A few other states charge one of their own, but Texas is not among them.

Can I buy coverage when I get sick?

Generally no. Outside open enrollment you need a qualifying life event, and a diagnosis is not one.

Does the Medicare penalty still exist?

Yes. Medicare's late enrollment penalties for Part B and Part D are permanent, and they have nothing to do with the ACA mandate.

Want this looked at properly?

We are an independent agency in McAllen serving Hidalgo, Cameron and Starr counties. There is no obligation to talk it through.

Call (956) 687 3334

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