Saving on Out-of-Pocket Costs
You must choose a Silver plan to get these savings
Shanti
10/4/20261 min read
Saving on Out-of-Pocket Costs
After you complete an application through the Marketplace and provide information about your household and income, you’ll find out whether you qualify for a premium tax credit. This credit can lower your monthly insurance premium.
You may also qualify for cost-sharing reductions based on your income. These savings can lower what you pay out of pocket when you receive medical care.
You must choose a Silver plan to get these savings
If you qualify for cost-sharing reductions, you must choose a Silver plan to receive them. If you choose a Bronze, Gold, or another plan category, you may still use the premium tax credit, but you won’t get the cost-sharing reductions.
If you have a Silver plan and later lose eligibility for these savings, you may qualify for a Special Enrollment Period to choose another plan.
How do cost-sharing reductions lower your costs?
If you qualify and enroll in a Silver plan, you may have:
• A lower deductible, so your insurance plan starts paying its share sooner.
• Lower copayments or coinsurance when you receive care.
• A lower out-of-pocket maximum, the most you would have to pay during the year for covered services.
For example, a plan’s deductible might be reduced from $750 to $300 or $500. A doctor visit copayment might go from $30 to $20 or $15. These are examples only; your actual costs depend on your income and the plan you choose.
How can I find out if I qualify?
After you apply, check your Eligibility Determination Notice. If it says you can choose a plan with lower copayments, coinsurance, and deductibles, and includes code (04), (05), or (06), you qualify for these income-based savings. You must choose a Silver plan to receive them.
Catastrophic plans don’t qualify for cost-sharing reductions or the premium tax credit.
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