Will I qualify for lower out-of-pocket costs?



When you get coverage through the Marketplace, you may be able to get lower costs on deductibles, copayments, and coinsurance.

This will depend on your household size and income. You can get these savings on out-of-pocket costs, known as “cost-sharing reductions,” only if you buy a plan in the Silver category.

The Marketplace cost-sharing reduction lowers the amount you have to pay for out-of-pocket costs like deductibles, coinsurance, and copayments. These are costs you have to pay when you get care.

Your savings on out-of-pocket costs are based on your household size and income, as shown on the chart below.

When you apply for coverage in the Marketplace, you'll learn if you’re eligible for savings on out-of-pocket costs.

Savings depend on your income

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

Incomes that qualify for cost-sharing reductions are higher in Alaska and Hawaii. See Alaska and Hawaii information.

Learn how to estimate your income and report on your household size.

If your income falls between the amounts shown, you also qualify for premium tax credits that lower how much your pay in monthly premiums.

Out-of-pocket savings apply only to Silver plans

Plans in the Marketplace are grouped into 4 categories: Bronze, Silver, Gold, and Platinum. These categories are based on how much you pay and how much the plan pays when you get medical care. They are not based on plan quality.

Learn more about plan categories and what they mean.

If you qualify for out-of-pocket savings, you must choose a Silver plan to get the savings. You can choose any category of plan, but you'll get the out-of-pocket savings only if you enroll in a Silver plan.

Find out if you may qualify for out-of-pocket savings

You can use the Kaiser Family Foundation calculator to see if you may qualify for lower out-of-pocket costs.

After you put some basic information into the calculator and get your results, scroll down to the “Out of Pocket Costs” section to learn how much savings you could qualify for.