Understanding Cost-Sharing Reductions in Health Insurance
What are Cost-Sharing Reductions (CSRs)?
Cost-sharing reductions (CSRs) are a type of financial help provided under the Affordable Care Act (ACA), also known as Obamacare. CSRs are often called “extra savings” or “discounts.”
CSRs help make health insurance more affordable by lowering the amount eligible individuals and families have to pay for their deductible, copays, coinsurance, and out-of-pocket maximum.
How Do Cost-Sharing Reductions Work?
Under the ACA, health insurance plans offered through the Health Insurance Marketplace are categorized into different metal levels: Bronze, Silver, Gold, and Platinum. Each metal tier corresponds to a different level of cost-sharing between the member and insurer. CSRs are only available for members enrolled in a Silver metal level plan who also meet certain income requirements.
It's important to note that CSRs are different from premium subsidies available under the ACA. Premium subsidies help lower the monthly cost of insurance for eligible individuals, while CSRs focus on further reducing out-of-pocket costs for covered medical services.
Due to potential changes to ACA premium tax credits, it's important to take steps and prepare before choosing a 2026 health plan. Learn how these changes may impact you.
Who Qualifies For Cost-Sharing Reductions?
To qualify for CSRs, individuals and families must meet the following criteria:
- Enrollment in a Silver plan: CSRs are only available to individuals and families enrolled in a Silver plan. CSRs are not available for those enrolled in Bronze, Gold, or Platinum plans.
- Income eligibility: The primary factor in determining eligibility for CSRs is the individual or family's income level. The income is evaluated as a percentage of the federal poverty level (FPL). The lower an individual or family’s income is in relation to the FPL, the more substantial the CSRs they may qualify for.
How Much Can I Expect To Save With a Cost-Sharing Reduction?
The amount individuals can save with CSRs varies based on the extra savings they qualify for and the specific Silver plan they choose.
For example, if a member would normally have a $1,000 deductible under a Silver plan, the cost-sharing reductions may lower it to $500 or even $0, depending on their income level.
One important feature of CSRs is the maximum out-of-pocket (MOOP) limit. The MOOP limit sets a cap on the total amount individuals and families must pay for covered healthcare services in a year. Once the MOOP limit is reached, the insurer covers 100% of the remaining costs for covered services. This limit is determined based on the individual or family’s income in relation to the Federal Poverty Limit. For example, the lower a household’s income, the more their out-of-pocket costs for care are reduced.
When exploring health coverage through the Marketplace, individuals and families can compare different options, including the estimated total yearly costs (monthly premium plus out-of-pocket expenses) for each plan. This can help provide a better understanding of the potential savings with CSRs and how they may impact the overall healthcare costs for an individual or family.
How Do I Find Out If I am Eligible For Cost-Sharing Reductions?
The best way to determine your eligibility for CSRs is to begin completing a Marketplace health plan application. Additionally, Anthem can guide you through the enrollment process, and help you find out if you’re eligible for savings.
Find the Right Plan For You
Compare Silver metal level plans from Anthem and find out if you qualify for extra savings. We can help you navigate your health insurance options to make the best choice for you and your family.
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Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. and AMGP Georgia Managed Care Company, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Community Care Health Plan of Nevada, Inc. and Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. HMO plans are administered by Anthem Health Plans of New Hampshire, Inc. and underwritten by either Matthew Thornton Health Plan, Inc. or Anthem Health Plans of New Hampshire, Inc. In 17 southeastern counties of New York: Anthem HealthChoice Assurance, Inc. and Anthem HealthChoice HMO, Inc. In these same counties Anthem Blue Cross and Blue Shield HP is the trade name of Anthem HP, LLC. In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield, and its affiliate HealthKeepers, Inc. trades as Anthem HealthKeepers providing HMO coverage, and their service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin (BCBSWI) underwrites or administers PPO and indemnity policies and underwrites the out-of-network benefits in POS policies offered by Compcare Health Services Insurance Corporation. Compcare underwrites or administers HMO or POS policies. Independent licensees of the Blue Cross and Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.
CA: Anthem Blue Cross is the trade name of Blue Cross of California. Independent licensee of the Blue Cross Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.
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