Form FTB 3853 is used to determine if you owe an individual shared responsibility penalty or to claim exemptions from the state individual health coverage mandate on your California state tax return. The Health Insurance Penalty section is found in the Credits and Taxes section of the California return.
You might be able to qualify for an exemption from having health insurance for the period of time in the situation you described. You can claim the following exemptions on your California tax return:
- Income is below the tax filing threshold
- Health coverage is considered unaffordable (exceeded 7.28% of household income for the 2025 taxable year)
- Families’ self-only coverage combined cost is unaffordable
- Short coverage gap of three consecutive months or less
- Certain non-citizens who are not lawfully present
- Certain citizens living abroad/residents of another state or U.S. territory
- Members of health care sharing ministry
- Members of federally-recognized Indian tribes including Alaskan Natives
- Incarceration (other than incarceration pending the disposition of charges)
- Member if applicable household born or adopted during the year
- Member of applicable household died during the year
- Enrolled in limited or restricted-scope Medi-Cal or other coverage from the California Department of Health Care Services
Beginning January 1, 2020, California residents must either:
- Have qualifying health insurance coverage
- Obtain an exemption from the requirement to have coverage
- Pay a penalty when they file their state tax return
See this Franchise Tax Board webpage for more information about the exemptions and the health care mandate.
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