The Marketplace cost-sharing reduction lowers the amount you have to pay for out-of-pocket costs like deductibles, coinsurance, and copayments.
Health insurance companies offering coverage through the Marketplace must lower how much you pay out of pocket when you get medical care if your household income falls between the following amounts. They do this only for Silver plans.
The lower your income within these ranges, the more you’ll save on out-of-pocket costs.
- $11,490 to $28,725 for individuals
- $15,510 to $38,775 for a family of 2
- $19,530 to $48,825 for a family of 3
- $23,550 to $58,875 for a family of 4
- $27,570 to $68,925 for a family of 5
- $31,590 to $78,975 for a family of 6
- $35,610 to $89,025 for a family of 7
- $39,630 to $99,075 for a family of 8
You can use the Kaiser Family Foundation calculator to see if you may qualify for lower out-of-pocket costs.
If the individual resides in a state that did expand Medicaid (such as Wisconsin) then they would not be able to get subsidies unless they were above 138%FPL.
Premium Tax Credit