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 your income qualifies you for extra savings known as “cost-sharing reductions.” If it does, you can save money a second way: by paying less out of pocket each time you get medical services.
Important: If you qualify for these extra savings on out-of-pocket costs, you get them only if you enroll in a plan in the Silver category. You can use a premium tax credit for a plan in any metal category but you’ll get extra cost-sharing reductions only if you pick a Silver plan.
Do You Qualify For Cost-Sharing Reductions?
You can visit this link to see if you qualify: HERE
If it does fall in the range, the amount you’ll save on out-of-pocket costs depends on your specific income estimate. The lower your income within the range, the more you’ll save.
You’ll find out exactly how much you’ll save only after you apply and shop for Silver plans in the Marketplace.
How Cost-Sharing Reductions Work
If you qualify for savings on out-of-pocket costs and enroll in a 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 for anything (other than for free preventative services). 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, would be lower. Instead of $5,000, your out-of-pocket maximum for a particular Silver plan could be $3,000