Cost Sharing Reduction (CSR)

What is a Cost Sharing Reduction?

A cost sharing reduction is financial help that lowers the amount you pay when you use health care services. Instead of lowering your monthly premium, CSR focuses on costs you pay at the doctor’s office, pharmacy, or hospital, like deductibles, copays, and coinsurance. 

If you qualify, CSR is built into the plan benefits you sign up for, so you get the lower cost-sharing automatically when you use covered services.

In most cases, CSR is only available with Silver Marketplace health insurance plans, which is why plan category matters when comparing options. 

Who Qualifies for Cost Sharing Reductions?

To qualify for CSR, you must:

• Choose a Silver Marketplace plan
• Have a household income between 100% and 250% of the federal poverty level
• Not qualify for other coverage like Medicaid or Medicare 

Income levels and CSR amounts:

• If your income is 100-150% of poverty level: You get the most help (lowest deductibles and copays)
• If your income is 150-200% of poverty level: You get medium help
• If your income is 200-250% of poverty level: You get some help
• If your income is over 250% of poverty level: You don't qualify for CSR

How This Shows Up in Real Life

Let’s say you sign up for a Silver Marketplace plan and qualify for cost sharing reductions. When you go to an in-network doctor, you may have a lower copay than you would with a regular Silver plan. For example, without CSR, your copay might be $40. With CSR, it might only be $15.

 If you need lab work or a prescription, you pay less out of pocket because your plan's deductible or coinsurance is lower. Let's say your regular deductible would be $3,000. With CSR, it might drop to $500 or even $0, depending on your income. This means your plan starts helping pay for care much sooner.

 The savings add up throughout the year, especially if you see doctors regularly or take prescription medicines. 

How This Changes Across Marketplace Plans 

Cost sharing reductions can change how a Silver plan works compared to other categories. The biggest difference is that CSR creates lower-cost versions of Silver plans for people who qualify, which can reduce what you pay when you receive care. 

• Silver plans — Usually the only plan category that includes cost sharing reductions for eligible members.
• Bronze plans — May have lower monthly premiums, but they usually have higher deductibles and do not include CSR benefits.
• Gold plans — May have higher monthly premiums and lower cost-sharing, but they usually do not include CSR benefits.
  • Note — Even within Silver plans, your costs can be different depending on whether your plan includes CSR and how your benefits are set up.

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