Cost Sharing Reductions


Cost Sharing Reductions | Health Insurance Quotes

Cost Sharing Reductions

 

Cost sharing reductions are a form of assistance offered by the health insurance exchanges to lower out of pocket costs. If you qualify based on income, the portion of costs you are required to pay providers changes the way your policy works, allowing you to exhaust your deductibles and out of pocket limits sooner.

 

When you apply for individual coverage through the Marketplace, your income and the state you live in will determine whether you qualify for a tax credit and cost sharing reductions. Below is a guide from the Centers for Medicare and Medicaid Services to how Cost Sharing Reduction calculations for 2016.

 

Find out if you qualify for a premium tax credit and cost sharing reductions:

Check Eligibility Online: Subsidy Calculator

Call a Licensed Insurance Agent: 888.803.5917

 

Plan Variation
(from 70% AV Silver Plan)

Income Range

for Individual*

Individual Out-of-Pocket Maximum
(Standard 2016 limit: $6,850)

Income Range for Family of Three*

Family Out-of-Pocket Maximum
(standard 2016 limit: $13,700)

94% AV Silver Plan Variation
(for households with a MAGI between 100-150% of FPL  )

$11,770- $17,655

$2,250

$20,090- $30,135

$4,500

87% AV Silver Plan Variation (for households with a MAGI between 150-200% of FPL)

$17,655- $23,540

$2,250

$30,135- $40,180

$4,500

73% AV Silver Plan Variation (for households with a MAGI between 200-250% of FPL)

$23,540- $29,425

$5,200

$40,180- $50,225

$10,400

American Indians/Alaska Natives with MAGI below 300% of FPL enrolled in a zero cost sharing plan variation have all cost sharing eliminated for EHB.

American Indians/Alaska Natives with MAGI above 300% of FPL enrolled in a limited cost sharing plan variation have cost sharing eliminated for any EHB item or service that is furnished directly by the Indian Health Service, an Indian Tribe, Tribal Organization, Urban Indian Organization, or through referral under contract health services.

*Please review the 2015 Federal Poverty Chart in the Resources tab to find dollar ranges for the different percentages of FPL. These figures are higher in Alaska and Hawaii.