How to choose Marketplace insurance

Out-of-pocket costs

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Get Lower Out of Pocket Costs in the Health Insurance Marketplace

It’s important to know how much you have to pay out of your pocket for services when you get care. You pay these out-of-pocket costs in addition to your monthly premiums.

The category of plan you choose affects how much you spend on out-of-pocket costs. Generally, Bronze and Silver plans have lower monthly premiums, but you’ll pay higher out-of-pocket costs when you need care. Gold and Platinum plans generally have higher premiums but lower out-of-pocket costs.

The maximum out-of-pocket costs for any Marketplace plan for 2015 are $6,600 for an individual plan and $13,200 for a family plan. This means when the amount you’ve paid in deductibles, copayments, and coinsurance reaches these limits, the insurance company pays 100% of your costs for covered care. Even if you choose a catastrophic coverage plan your out-of-pocket costs shouldn’t exceed this limit.

Savings on out-of-pocket costs with a Silver plan

If you qualify for lower out-of-pocket costs based on your household size and income and choose a Silver plan, you can save more. This is called a “cost-sharing reduction.”

With a cost-sharing reduction, you’ll pay lower deductibles, copayments, and coinsurance. You'll basically get the lower out-of-pocket costs of a Gold or Platinum plan while paying a Silver plan premium. You can choose any category of plan, but you get these savings on out-of-pocket costs only if you enroll in a Silver plan.

If you make $11,670 to $29,175 for individuals or $23,850 to $59,625 for a family of 4, you may be eligible for a cost-sharing reduction. The lower your income within these ranges, the more you’ll save on out-of-pocket costs.

Get more information about cost-sharing reductions for American Indians and Alaska Natives.