Cost-Sharing Reductions

Cost-Sharing Reductions in (Less Than) 90 Seconds:

A Basic Explanation

If you qualify, the Affordable Care Act (ACA) can help you afford insurance by paying part of your healthcare costs. With a cost-sharing reduction, the government will help pay your copay, deductible, and coinsurance. That means you’ll spend less when you go to the doctor or get prescription medicine. You can only use cost-sharing reductions if you buy a silver tier plan. Also, you have to see a provider in your plan’s network.

Cost-Sharing Reductions at a Glance

Cost-Sharing Reductions Animation

Expert Advice About Cost-Sharing Reductions

If you qualify for cost-sharing reductions, going to the doctor will be a lot easier on your wallet. Same goes for buying your prescription medications. That's because the government will pay part of your copay, coinsurance, and deductible. Here are some steps to take to access that help:

1. Find out if you qualify for cost-sharing reductions. The subsidy amount is based on how much money you earn per year. To find out whether you're likely to qualify, the easiest thing to do is use the GetInsured Estimator. You'll be asked to provide information about your expected household income and the ages of other people in your household.

2. Buy your health insurance in the right place. If your initial calculation predicts that you’ll get a subsidy -- or even that you’re close to qualifying -- you’ll want to shop someplace where you can access your subsidy. You can do that in three ways:

  • With some qualified Web brokers. A few private companies have signed agreements with the federal government allowing them to help customers access cost-sharing reductions. (GetInsured is one of those brokers.) Know that not all Web brokers are licensed to do this. You’ll want to double-check before shopping.
  • On your state’s marketplace. If your state has set up its own marketplace, you can shop there and access your cost-sharing reduction. If you'd like help shopping your state's marketplace, GetInsured's certified, licensed agents can help; just call.
  • On the federal marketplace. The federal government has set up its own marketplace. If you live in a state that doesn’t have a state marketplace, you can shop on the federal site and access your cost-sharing reduction that way. Again, count on GetInsured's certified, licensed agents for help if you need it.

Buying your health coverage on one of these three marketplaces is also smart because even if you’re not currently eligible for cost-sharing, if for whatever reason your income drops over the year and you become eligible, you’ll be able to access your subsidy.

3. Buy a silver tier plan. Remember the different metal tiers for health insurance plans? Here's where those tiers matter most: You can only use a cost-sharing reduction if you purchase a silver-tier plan. So even though silver tier plans might have a slightly higher premium than bronze, when you do the math, you may discover that cost-sharing reductions make silver plans the better deal after all.