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.
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.
|Family members||Income below (for cost sharing)|
If you qualify for savings on out-of-pocket costs and enroll in Silver plan:
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.
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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