For the new healthcare reform act everyone who wants to apply for a federal subsidy must have a tax return from tax year 2012.  When the federal exchanges open in October of 2013 you can apply to get a federal subsidy to help pay your insurance costs if you purchase health insurance through the exchange.  If you do not have health insurance for tax season 2013 you will get a penalty from both the state of Massachusetts and the Federal government.  These penalties could be hundreds of dollars from each tax authority.