What if Your Insurance Plan Doesn’t Cover Prescription Drugs

No Drugs Plans

In a world of ever-changing medical care, insurance plans might not always cover certain aspects of health such as prescription drugs. This could be a result of someone not feeling the need to have prescription drug coverage, or maybe they can’t afford it.

Whatever the reasons, it’s important to note that insurance coverage rules can vary from state to state. There are several ways that health plans cover prescription drugs if you do opt for that type of coverage: Copays, coinsurance, prescription deductible, integrated deductible, out-of-pocket maximum.

This article will discuss prescription drug coverage, or lack of, and how you can get find a plan that works for your needs.


Prescription drug spending in the United States grew to nearly $370 billion in 2019, “accounting for nearly 10 percent of total health expenditures,” according to Very Well Health.

Of course, the pandemic likely had a huge effect on these numbers, as more adults found themselves focusing their attention on the health and medical industries due to the financial and medical crises.

In addition, the CDC said that 48.6 percent of adults had used at least one prescription drug within 30 days, with 24 percent having used three or more, and 12.8 percent having used five or more.


  • The average increase for generic drugs is in the range of 15% annually.

According to the Organization for Economic Co-Operation and Development, Americans spend, on average, about $1,200 each year on prescription drugs. The most popular prescription drugs range in cost from $12.41- $97.57.

You can read more about the cost of prescription drugs in this article.

Given the cost of prescriptions, it’s clear that prescription drug coverage is a significant part of a comprehensive health insurance plan. But as drug prices rise, many insurance companies have put more restrictions on what they will and will not cover.

That means that even Americans who are enrolled in a plan with prescription drug coverage may incur substantial out-of-pocket costs.


Several factors affect the cost of prescription drugs, including generic or brand-name prescriptions, where you get your prescription filled, and how long you are on the medication.

Read the complete article on Very Well Health to learn more about this topic.


According to Harvard health economist and primary care physician Ben Sommers, “There’s more and more evidence that having health insurance really does improve people’s health, and medications are one of the key parts of that because it is a mainstay of how we manage a lot of chronic conditions.”

But having health insurance doesn’t mean easy access to the needed drugs.

The majority of Americans have health insurance that includes coverage for prescription drugs. But unfortunately that doesn’t ensure that they can afford the specific drugs their doctors prescribe for them, according to an article published by NPR.

This same article highlighted one poll that was released on income inequality: “Many Americans report that their insurance plans sometimes don’t cover a drug they need — and nearly half the people whom this happens to say they simply don’t fill the prescription.”

Continue Reading: When Insurance Won’t Cover Drugs, Americans Make ‘Tough Choices’ About Their Health

So, what happens when an individual’s insurance doesn’t or won’t cover prescription drugs? Well, the individual simply doesn’t buy or take their medication.

In fact, there are experiences of individuals with Medicare who pay for supplemental insurance policies just to cover the cost of the needed drugs — and that’s just for the generic version which typically results in lower quality, less-than effectual results, and out-of-pocket expenses.

For those who prioritize prescription drugs over everything else, there are resources or ways to hone in on this type of coverage.


While it might be tempting to just give up on trying to get prescription drug coverage, experts say that isn’t the route that should be taken.

“Patients struggling with their health may not understand or have the ability to push back when an insurance company sends a denial,” says Frederick Isasi, director of the consumer advocacy group Families USA. So here are different ways to get prescription drug coverage.

 Prescription Assistance Programs: 

Prescription assistance programs help patients pay for the medications at an affordable rate. Pharmaceutical companies create them to provide free or discounted prescriptions for those who need them. Patients usually have to apply to receive assistance.

 Call different pharmacies: 

As stated above, you will oftentimes find that different pharmacies will offer various rates of the same prescription. Therefore, before choosing a pharmacy, you may want to call around to see which pharmacy offers the best price.

 Ask for a 90-day supply: 

While a 30-day refill option is usually the most common, a study found that getting a 90 day supply of medication can save patients a significant amount of money. However, this option is only appropriate if you are taking maintenance medications.

 Use coupons: 

Before purchasing your prescription, you can look around for coupons that will save you money. One way to do this is by using MiraRx, where you can look at discounts from different pharmacies in your area and choose the best price.

Standalone Prescription Drug Coverage (Medicare Part D):

Medicare Part D is a type of insurance plan that Medicare beneficiaries purchase to supplement Original Medicare (or to supplement a Medicare Advantage plan that doesn’t already come with built-in Part D coverage.

The plans are called “stand-alone” because they’re purchased on their own, separate from the rest of the person’s health coverage; similar to what was addressed previously, this option is common for an Original Medicare beneficiary, resulting in a Part D plan from one insurer and a Medigap plan from a different insurer, according to the Health Insurance online organization.

You might also hear someone refer to stand-alone prescription drug coverage for people who aren’t enrolled in Medicare, although that’s much less common.

Some things to keep in mind:

  • Original Medicare is the only major type of health coverage that doesn’t include prescription drug coverage, requiring enrollees to purchase supplemental stand-alone drug coverage.

Medicare Part D is true insurance, but in most other cases, if people are buying stand-alone drug coverage, they may be getting a prescription discount program rather than an actual insurance plan.


What is the Penalty for not Purchasing Health Insurance

For those on the fence, here are the penalties for not purchasing health insurance coverage

This is vital information for those who are on the fence about whether they should purchase coverage or not. Beginning in 2020, the California individual mandate required that all California residents maintain minimum essential health coverage (MEC) for each month of the year.

If you haven’t had health insurance for whatever reason, it’s important to understand the penalties for what happens down the line when filing taxes. While this is focusing on Californians, individuals in states across the country could be affected in similar ways.


People might wonder why the U.S. government emphasizes health insurance. In summary, there are two primary reasons to have health insurance:

• Health insurance supports you if you get sick
• Health insurance helps you avoid getting sick to begin with

Health Insurance Supports You if You Get Sick.

Most people can’t pay for all their health care out-of-pocket and opt to put it on a debit or credit card. But that’s just another financial burden that’ll have to be addressed at some point.

Health insurance provides financial protection in case you have a serious accident or illness.

For example, a broken leg can cost up to $7,500 — who has that amount of money just laying around to be used, and on a broken leg, at that? Chances are, if you’ve got $7,500 to put toward a broken leg, you’re better off paying for monthly health coverage, as it can help protect you from those high, unexpected costs.

Read more about the benefits of having health insurance coverage here and here.

Health Insurance Helps You Avoid Getting Sick to Begin With (the “I don’t need health insurance because I don’t get sick” Debate)

Does this sound familiar? Some of us have shared similar thoughts in the past, and this is especially the case with individuals who pay attention to their health, eat well, exercise on a regular basis, and simply don’t get sick often.

But forgoing health insurance coverage still isn’t recommended.

You might think that signing up for health insurance, paying a monthly premium, and not getting sick or receiving any health care is a loss of money. But it isn’t.

  • There are many health insurance benefits you can use even without getting sick, such as vaccinations and checkups, that help keep you healthy over the long run.
  • Even if you don’t get into an accident, have large health care costs, or need to use your health insurance benefits, you still get the peace of mind of knowing that, if you had gotten sick, you wouldn’t be facing all those medical costs on your own.

So, what happens if you don’t have health insurance coverage? Well, your taxes will be affected.


MEC includes employer sponsored insurance, individual market coverage purchased through Covered California or directly from issuers, Medicare Parts A and C, and most Medi-Cal coverage.

Those who do not meet this requirement must pay a penalty on their state income tax return unless they qualify for an exemption.

For 2021, the amount of the penalty for not having qualifying health insurance has increased. As a reminder, there are two methods of calculating the penalty, and a household will pay whichever calculation yields the larger penalty:

• A flat amount based on the number of people in the household – $800 per adult 18 years or older and $400 per dependent child for no coverage for an entire year; up to an annual max of $2,400.
• A percentage of the household income – 2.5% of all gross household income over the tax filing threshold.
• The California Franchise Tax Board (FTB) launched the individual mandate penalty estimator in 2020 to help consumers calculate the penalty they may owe if they go without qualifying health coverage.


Exemptions mean the fee for not having health insurance no longer applies. Here are the exemptions:

  • If you’re 30 or older and want a “Catastrophic” health plan, you must apply for a hardship exemption to qualify. See details about exemptions and catastrophic coverage.
  • If you live in Maryland, visit Maryland Health Connection for information on exemptions.
  • If you live in the District of Columbia, visit DC Health Link.
  • If you live in California, visit Covered California.

Let’s talk briefly about that final point geared toward Californians. According to the official CoveredCA.com website: “Covered California is a free service that connects Californians with brand-name health insurance … [providing] financial help when you buy health insurance from well-known companies.”

We encourage you to check out the website to learn more about your health coverage options.

And if you have more questions, reach out to us for more information; we’ll be happy to help. https://www.bdhealthinsurance.com/contact-bernardini-donovan-insurance/

Free COBRA health insurance ends Sept. 30: 3 options for the unemployed

COBRAs premium health insurance ends Sept 30

Overview: Unemployed? Here are 3 things you could do when your COBRA’s premium health insurance ends Sept. 30

  • Switch to an Affordable Care Act policy once your free coverage ends

  • Qualify for a special enrollment period (SEP)

  • Talk to your plan administrator and/or former employer

COBRA health insurance ends Sept. 30When Sept. 30 rolls around, it’ll be goodbye to that premium health coverage from COBRA and hello to many, many questions (and a bit of financial panic for the unemployed). But we’ll start by saying you shouldn’t panic — there are options that unemployed individuals could and should begin to consider now.

Keep these things in mind: It’s true that after Sept. 30, the group health plan can charge the usual COBRA premium for the coverage. And the premium assistance lasts through Sept. 30 but may end sooner if you reach the end of your maximum COBRA continuation coverage period which is, generally, 18 months.


Option 1: Switch to an Affordable Care Act policy once your free coverage ends.

The special enrollment period for Affordable Care Act coverage ends Aug. 15. Here’s why it’s a useful option: ACA policies — by contrast to COBRA coverage — are typically subsidized with tax credits that make the coverage more affordable.

In one particular case, a spouse lost their job and was on COBRA continuation coverage for health insurance. They didn’t have to pay the premiums (through Sept. 30) as a result of the American Rescue Plan (passed in March). The question was asked if there was anything available on Oct. 1 if the spouse was still unemployed by that time.

The American Rescue Plan requires employers to pay COBRA premiums for eligible former employees for April through September. The employers will be reimbursed through a tax credit. (The subsidy may last fewer than six months if someone’s COBRA eligibility ends before September, or if they become eligible for group coverage through their job or their spouse’s job.)

When the premium-free coverage ends, the spouse would qualify for a special enrollment period that allows them to switch to an Affordable Care Act policy. Not only that, but anyone who is unemployed at any point during 2021 will qualify for a premium-free comprehensive policy through the ACA for the rest of the year.

Related reading(s): What you need to do when free health insurance for unemployed people ends Sept. 30

Option 2: Qualify for a special enrollment period (SEP) to enroll in individual market health insurance coverage, such as through a Health Insurance Marketplace®.

When your COBRA premium assistance ends, you may be eligible for a SEP to enroll in coverage through a Health Insurance Marketplace®, or to enroll in individual health insurance coverage outside of the Marketplace. You may also qualify for a SEP when you reach the end of your maximum COBRA coverage period. Below are links to additional information.

  • For more information about enrolling in Marketplace coverage, see:

    • HealthCare.gov

    • Or you can call 1-800-318-2596 (TTY: 1-855-889-4325).

If your state has its own Marketplace platform, find contact information for your State Marketplace here:

You may apply for and, if eligible, enroll in Medicaid coverage at any time. For more information, go to:


Option 3: Talk to your plan administrator and/or former employer

Karen Pollitz, a senior fellow with the Kaiser Family Foundation, said some employers and COBRA administrators were still working out the details. If you believe you are eligible for the subsidy that ends after Sept. 30 and haven’t received a notice with the required forms, you can notify your former employer. In more detail, Pollitz encourages individuals to:

  1. Notify their former employer

  1. Fill out and sign this form, published by the Department of Labor

    1. Turn the form into your plan administrator if you’re already enrolled in COBRA

    2. Send the form to your former employer if you’re trying to sign up

Pollitz said if you have a relationship with your provider, you could also ask if it’s possible to wait a little longer to bill your insurer until the COBRA coverage kicks in.

Related reading(s): Stimulus Provides Free COBRA Health Insurance for Unemployed; What You Need to Know


Remember: The Affordable Care Act is over 60,000 pages long. Medicare is written over tens of thousands of pages. And Insurance Laws and Regulations are profoundly extensive. So if you’re wondering what to do when COBRA’s premium health insurance ends, we can help.

We understand that there is not a single “best” plan when it comes to health insurance — and it’s even more complicated when unemployment is involved. And we understand that your needs are unique.

This is where we come in. Contact us to get your questions answered! We’ll offer our expertise in health insurance so you’re taken care of during these complicated times.


Employee Life Insurance

Employee life insurance

Employee Life Insurance

Life insurance serves as a safety net to the dependents of an employee in the case of their death. This is especially necessary for those who have families that rely on their income for support. And most often, such assurance is built through one’s employer. That’s why, for most job seekers, they require that their future employer offers life insurance .In this article, we will discuss the different types of employee life insurance and ways that it can be purchased.

Many employers offer basic life insurance to their employees as part of their benefits package either for free or at a very low cost. This is typically a predetermined, fixed amount that usually equates to the employee’s salary. For most people, if they are single and have no dependents, this initial amount is plenty, and they are unlikely to purchase more coverage. However, most companies provide the option to buy supplemental life insurance for whoever requires it– typically those with children.

The benefit of offering employee life insurance:

Providing life insurance to potential employees will attract talented professionals and make your business stand out as a preferred employer. That’s because job seekers everywhere hope to have peace of mind in the case of their death and assurance that their loved ones will be financially cared for. This financial cushion for the employee’s survivors is an essential aspect of their benefits package. So, keep in mind as an employer, that not only will providing life insurance be attractive to potential employees, but it may be expected as well. Life insurance, however, is not offered in one fixed way. There are a variety of means for providing life insurance to employees.

Ways to purchase employee life insurance:

Term Life Insurance– This is the simplest way to buy life insurance as it does not involve an investment component. Most financial advisors will recommend opting for this variety as it is uncomplicated and sufficient for the needs of most employees. Term life insurance suggests that the employer of the insured pays a monthly, quarterly, or annual fee for the agreed-upon amount of coverage. While no investment or cash value will accumulate or build in this type of insurance policy, the account is paid in full back to the survivors upon the death of the employer.

Short Term Life Insurance– These policies work like term life insurance, with the exception that they have a time limit of some sort. In some facets, the premium fee increases gradually with the age of the employee. In others, there is an expiration date, typically at the age of 70.

Permanent Life Insurance– These types of policies build gain value over time and tend to be more expensive. And especially older patients will need to pay a significant premium fee for their benefits. There are various types of permanent life insurance plans. The most common, however, are whole life, variable life, and universal life.

Types of Permanent Life Insurance:

Whole Life Insurance– This type of insurance is considered an investment because it will accumulate money that can be withdrawn in the case of an emergency. As long as you pay the premium, it will cover you for your entire life. However, you can initiate the end of the policy if you choose to cash in on it before you die. Despite this potential perk, most experts would not consider this a particularly good investment as the rate of return is typically pretty small.

Variable Life Insurance– This, like any policy, will provide money to an employee’s beneficiaries when they die. It is referred to as variable because it allows the insured to distribute the premium paid to a separate account, which could be composed of multiple investment funds. These could be a stock fund, money market account, or a bond fund. The value of this policy will depend on one’s investments, in addition to the minimum required by the insurance company.

Universal Life Insurance– This facet comes with a savings component that builds on a tax-deferred basis. So, a part of the employee’s premium will be invested by the insurance company in bonds, mortgages, and money market funds. And this return rate from these investments will be awarded to the policyholder on a tax-deferred basis. But, despite the performance of the company’s investments, the employee will still receive a minimum return of 4 percent.

Employee life insurance, among all company-provided health benefits, is appreciated and sought after by job seekers everywhere. In fact, in most cases, it is expected and necessary, especially among those with several dependents. So, as an employer, be sure that you can offer your employees and future team members the peace of mind that life insurance brings. If you have any concerns or questions regarding this subject, please do not hesitate to reach out to us at Bernardini and Donovan. Our team of experts is prepared to assist you as you prepare to offer your employees life insurance!

Outside of Your Coverage ?

health insurance

Outside of Your Coverage?coverage insurance

One of the most significant selling points of any insurance is that it brings peace of mind. Knowing that your well being and costs are being taken care of should anything happen to you or your family helps provide a sense of comfortable peace. But it would be foolish to assume that your Insurance will Cover Everything that could go wrong. That’s why you want to know exactly what is included in your home insurance and what your deductible is with your car insurance. There is the same train of thought with your health insurance. There are basics of your health coverage that you can always expect. Most of that includes preventative care such as doctor’s visits and hospitalization. However, not all care is covered.


There may be times that your doctor recommends a Specialist for surgery or some other care-related need. If they recommend someone outside of your coverage, you can find yourself in a tricky situation. One of our first recommendations is to ask your doctor if they can recommend anyone that is within your coverage. If they do not know anyone, then you can ask your insurance company to do the leg work. Ask them for a specialist that is within your insurance coverage. You can even ask them to cast a broader net to surrounding areas if you feel like you are not finding the specialist that is right for you. If you find someone within your coverage, great! Meet with them and make sure that you feel entirely comfortable with them and ensure that they feel confident in your treatment.  It can also be in your best interest to at least see the first recommended specialist. They can serve as a second opinion.

If you do end up paying out of pocket, try to negotiate the best price possible before the surgery. Go over Outside of Your Coverageevery possible expense and work with the hospital to ensure that any discounts that are available are applied. Also, please do not ignore the hospital’s collection department. It may seem like they are just like every other collection agency out there. However, they are trying to help you! They can help set you up on a payment plan as well as lower the cost of the final amount that you owe the hospital. It is in your best interest to become one of their favorite clients.

We hope that these ideas help you if you should ever find yourself needing care outside of your coverage. If you ever need to readdress your health care insurance needs, please always feel free to call us.

What to consider prior to buying health insurance for you and your family

As the time comes for open enrollment or to renew your health insurance, here are some helpful hints to look at before your purchase a plan.

Look before you renew
As the landscape for health insurance continues to change it is important that you make sure that your fully check out your options before opting to renew. Not only do the options available in your plan change from year to year but your personal circumstances change. You may have moved, found a new job, or had a child and all of these can change what you need from your provider. Also, if your plan is being replaced make sure you fully look over what it is being replaced with so you are not surprised later down the road and find that what you need is not covered.

Doctors and prescriptions, oh my…
You will want to make sure that your preferred doctor accepts that coverage before you enroll. And going to a doctor outside of your coverage can cost you substantially more that going in your plan. Also, you will want to know what your prescription medication is going to cost you. Most companies will assign medications to a different level or tier so that between different companies the medication you need may be covered but it may be on a different tier and therefore would cost you much more.

Consult an insurance broker
When the Affordable Care Act come into effect its purpose was to let people comparison shop relatively easily for different health care options. However, the health care market is wide and varied and you can very easily not see a special savings or find out that what you need is not covered when it is too late. Health Insurance brokers are working hard to stay ahead of the changes in the law, know all the different nuances of plans being offered and want to help you find your best fit. Contact us at Bernardini & Donovan and let us help you look beyond the bare essentials to finding a package that fits you and your family perfectly.

Changes to Covered California are Coming

Change is inevitable. Each day when you wake you just can’t be sure what that day will bring. Granted, sometimes you get a heads up. Like when you see the storm clouds brewing off in the distance, it’s a good idea to bring your umbrella. Or when you hear of a huge traffic hold up on your normal commute, you avoid that route and take the side roads. So here is your heads up when it comes to Covered California rates. They are going up to the tune of 13.2%

For the past two years California has been able to negotiate to keep the rates in an affordable increase averaging around a 4% increase. However, the legislation that allowed for them to do that is now is now expiring. With these rate increases we will see California’s rates being more comparable to the rest of the nation whose rates have been rising steadily over the past few years.

Also, if you are small business owner with 50-100 employees, the laws are changing for your health coverage. If you have 50 and up to 100 full time eligible employees then it is required that you provide health insurance for your employees.

So why are these changes happening? Peter Lee, the executive director of Covered California says that “Under the new rules of the Affordable Care Act, insurers face strict limits on the amount of profit they can make selling health insurance… We can be confident their rate increases are directly linked to health care costs, not administration or profit, which averaged 1.5 percent across our contracted plans.”
Of course as our country continues in our heated political race this discussion will continue to play a part as the presidential candidates weigh in on the effectiveness of the Affordable Care Act. With this change coming it will be interesting to see the full effects of these coming changes.

Covered California and Small Businesses

Looking into insurance for your employees at your small business? What does Covered California have to offer you as a small business employer? Well, we are glad you asked. Here is some basic information about what you could expect:

First, let’s define a small business. Covered California defines a small business as any business with under 100 full time equivalent employees which is a W-2 employee working 30 hours a week measured on a monthly basis. Covered California offers a variety of health insurance plans to puts you in charge of your health insurance budget while letting your employees get to choose from affordable, quality, and popular health insurance plans from private health insurance companies. The plans have levels of Bronze, Silver, Gold or Platinum. As an employer you can chose one or two plan levels of coverage to offer employees and define the amount they will contribute towards their employee premium. At that point the employee has the choice of which plan will meet their families needs. But regardless of the plan that they choose, all the plans offer these 10 basic benefits:

1. Doctor Visits
2. Prescription Drugs
3. Emergency Services
4. Pediatric Care with Dental and Vision
5. Lab Services
6. Maternity and Newborn Care
7. Hospitalization
8. Preventive and wellness care
9. Rehabilitation
10. Mental health and substance abuse services

You can enroll in Covered California at any time and the coverage will last for the 12 months following when you signed up. You can also add new employees to the program throughout the year as they get hired. You may even be eligible small business tax credit to offset the cost of providing insurance. To find out more about Covered California, more of what is offered, if this could be a good fit for your business and what is needed to qualify for the small business tax credit contact us at Bernardini & Donovan. We are experts in all the ins and outs Covered California and can help you make the best choice that fits your unique situation.

To offer health insurance or to not offer health insurance, that is the question…

When you run a small business there are a lot of different things on your plate and you wear a lot of different hats. Who is going to make sure the photo copier gets fixed? You are. Who is going to ensure that those invoices get paid? You are. Who is going to oversee the marketing and branding of your business? You are. And who is going to make sure that your employees are cared and happy? You are. When you are looking at the well being of your employees one of the first things that comes to mind is to offer health insurance. But in this new world of health insurance laws offering this benefit to your employees can bring with it additional costs and premiums for you, confusing jargon and still may not be exactly what your employees want.

When the Affordable Care Act was first brought on to the scene many small businesses opted to no longer provide health coverage for their employees. That was because they were given very little incentive at that time and little time to fully understand the programs they would be signing up for. Additionally, their employees could now pick their own insurance program.

However, some employers in the past few years have started to look at how they might be able to offer their employees either some form of coverage or help with paying for health insurance. The benefits for them were that they wanted to help their employees with their financial burdens. Only around 44% of Americans today say that they feel in control of their finances. This was also a great way for them to make themselves stand out when looking to hire new employees and retain the employees they already had.

If you are a small business owner and want to look into the different options available to you come speak to us at Bernardini & Donovan. We want to ensure your success and the happiness of your employees by offering the best health care solutions for your unique situation.

What To Do When You Miss the Insurance Enrollment Deadline

The healthcare marketplace officially closed on January 31. That can mean big trouble if you did not enroll in a healthcare plan and do not have one through an employer. However, there are ways you can enroll after the enrollment deadline. There are some catches though. There is a special enrollment period outside of the open enrollment period. To be able to sign up for health insurance through the marketplace after the open enrollment period, you must have a qualifying life event.


What is Classified as a Qualified Life Event?

There are some common life events that allow you to enroll after the deadline. Some of these include, but are not limited to, the following:


  • Getting married (or divorced)
  • Losing health insurance coverage from another party
  • Having a baby
  • Adopting a baby or placing one for adoption
  • Leaving prison
  • Losing coverage due to age (i.e. turning 26 and losing parental coverage)
  • Moving to another region (there are stipulations with this one)
  • Gaining U.S. citizenship or a lawful presence
  • Having a major income change
  • Having a “complex” situation that prevented you from enrolling before the deadline

15875161_lWhat To Do NextIf you qualify for one of these special circumstances, you should enroll as soon as you qualify. There is still a window of time where you can enroll based off of the life event but if you miss it, you will either have to wait for another life event or open enrollment the following year. If you do not qualify for any of these life events, you will either need to find employment where you can enroll in a plan or pay the fee during tax season. Also, be sure to mark your calendar for the next open enrollment period beginning November 15.41044361_lTax PenaltyYou should be as prepared as possible for the penalty for not enrolling in a plan. This year, the amount has increased per person. There are two ways to calculate it and you pay the penalty that is greater of the two options. The first way this is determined is through a calculation of the percentage of household income. For 2016, the percentage has increased to 2.5%. The maximum deduction through this method is equal to the total yearly premium of a Bronze plan through the marketplace (the national average). The other way this is calculated is per person. For 2016, the rate is $695 per adult and $347.50 per child that is under the age of 18. The maximum penalty for the household through this method is $2,085.Health insurance is required by law. If you missed the deadline and have questions about enrolling, contact us to explore your options.

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