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How to save on out-of-pocket costs with a Silver plan

After you fill out an application with the Health Insurance Marketplace and provide household and income information, you’ll find out if you qualify for a premium tax credit that lowers your monthly health insurance bill.

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You’ll also find out if, in addition, you qualify for “cost-sharing reductions.” This means you’ll pay less out of your own pocket when you get medical care, possibly saving hundreds or even thousands of dollars.

IMPORTANT: If you qualify for savings on out-of-pocket costs, you get them only if you enroll in a plan in the Silver category. You can enroll in any metal category you want, but you’ll get cost-sharing reductions only if you pick a Silver plan.

  • While a Silver plan may have a monthly premium that’s higher than a Bronze plan’s, be sure to consider the total cost of your medical care. Your total costs include not just monthly premiums but the payments you make when you get care.
  • If you have a Silver plan and qualify for out-of-pocket savings, the deductible is thousands of dollars less than a typical Bronze plan’s. So you may end up spending less on health care overall if you enroll in a Silver plan.

Will you save on out-of-pocket costs?

  • If it does fall in the range, the amount you’ll save on out-of-pocket costs depends on you income estimate. The lower your income within the range, the more you’ll save.
  • You’ll find out exactly how much you’ll save out-of-pocket only after you apply and shop for Silver plans in the Health Insurance Marketplace.

Household income ranges for savings on out-of-pocket costs

Family members Income below (for cost sharing)
1 $29,701
2 $40,051
3 $50,401
4 $60,751
5 $71,101
6 $81,451

How out-of-pocket savings work

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. 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 cost-sharing reductions 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, if you qualify for cost-sharing reductions, could be $3,000.

Important: The above are just examples to illustrate how cost-sharing reductions work. Plans in all categories have a wide range of deductibles, copayments/coinsurance, and out-of-pocket maximums. You will know exactly how much you save on out-of-pocket costs only when you shop for Silver plans in the Marketplace.

More answers: Savings on out-of-pocket costs

After you apply for Marketplace coverage, check your Eligibility Determination Notice. If it says “Can choose a health plan with lower copayments, coinsurance, and deductibles” and is followed by (04), (05), or (06), you qualify for income-based savings — but only if you pick a Silver plan.

No. Cost-sharing reductions apply only to Silver plans. (Catastrophic plans are also not eligible for a premium tax credit, no matter what your income is.)


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