A cost sharing reduction is a discount that lowers the amount you have to pay for deductibles, copayments, and coinsurance.
If your income is between 100% and 250% of the federal poverty level, you can qualify for cost sharing reductions.
The cost sharing reductions will be available through modified versions of Silver plans that are offered on the Marketplace. These plans will have lower deductibles, copays, coinsurance and out-of-pocket limits compared to regular Silver plans. Once the Marketplace determines you are eligible for cost sharing reductions, you will be able to select one of these modified Silver plans, based on your income level.
Here’s how it works
If you qualify for savings on out-of-pocket costs and enroll in Silver plan:
- You’ll have a lower deductible. This means the insurance plan starts to pay its share of your medical costs sooner. For example, if a particular Silver plan has a $750 deductible, you have to pay the first $750 of medical care yourself before the insurance company pays anything (other than free preventive services). But if you qualify for cost-sharing reductions your deductible for a Silver plan could be $300 or $500, depending on your income.
- You’ll have lower copayments or coinsurance. These are the payments you make each time you get care – like $30 for a doctor visit. If a Silver plan’s copayment is $30 for a doctor’s visit, if you enroll in the plan and qualify for extra savings, you may pay $20 or $15 instead.
- You’ll have a lower “out-of-pocket maximum”. This means the total amount you’d have to pay in a year if you used a lot of care, like if you got seriously sick or had an accident, will be lower. Instead of $5,000, your out-of-pocket maximum for a particular Silver plan could be $3,000.