Who is eligible for the Silver 73 cost share reduction plan was just expanded?
Asked by: Lolita Mraz | Last update: June 19, 2025Score: 4.5/5 (64 votes)
Who qualifies for cost sharing reductions in the Silver plan?
Individuals and families with incomes up to 250 percent of the poverty line are eligible for cost-sharing reductions if they are eligible for a premium tax credit and purchase a silver plan through the ACA marketplace in their state. People with lower incomes receive the most assistance.
What does a 73% cost sharing reduction mean?
A 73% cost sharing reduction means that your insurance company will pay an average of 73% of your health care costs while you'll pay the remaining 27%. This is a better deal than a regular Silver plan where you'll pay 30% of your medical costs.
How do I know if I qualify for CSR?
If you make under 250% of the Federal Poverty Level (under $64,505 for a family of four), you may qualify for cost sharing reduction (CSR). This means better benefits for you at the same monthly premium. For example, instead of paying a $45 doctor visit, cost sharing may lower your doctor visit copayment down to $5.
Who qualifies for the Covered California subsidy?
Families of four who earn wages below the median household income in California — $97,200 per year — qualify for government assistance based on their income. If the family has a lower household net income, more government assistance is available to the family. Tax deductions can lower your income level.
Out of Pocket Costs: Understanding Health Insurance
How do I check Medi-Cal eligibility?
Who is eligible? Qualify for Medi-Cal if your income is up to 138 percent of the Federal Poverty Level (FPL) for adults, and up to 266 percent FPL for children. Check Shop and Compare to see if you qualify. Learn more on the Department of Health Care Services website.
Who qualifies for subsidy?
- In states that have expanded Medicaid coverage, your household income must be below 138% of the federal poverty level (FPL) to qualify.
- In all states, your household income must be between 100% and 400% FPL to qualify for a premium tax credit that can lower your insurance costs.
What disqualifies you from the premium tax credit?
For tax years other than 2021 and 2022, if your household income on your tax return is more than 400 percent of the federal poverty line for your family size, you are not allowed a premium tax credit and will have to repay all of the advance credit payments made on behalf of you and your tax family members.
What is covered under Obamacare Silver Plan?
Benefits of Silver Healthcare Plans
Hospitalization (surgery and overnight stays) Pregnancy, maternity, and newborn care. Mental health and substance use disorder services, including behavioral health treatment (includes counseling and psychotherapy) Prescription drugs.
Who qualifies for CSR?
Typically, individuals and families with household incomes between 100 and 250 percent of the FPL may be eligible to receive CSRs.
What is the difference between silver 73 and silver 70?
Unlike the other coverage levels, Silver comes in four varieties: Standard Silver (also known as Silver 70), Silver 73, Silver 87 and Silver 94. The numbers refer to the percentage of expenses paid by your plan, with you picking up the rest (for Silver 73, you're on the hook for 27 percent of your expenses).
What happens if I overestimate my income for marketplace insurance?
If you overestimate your income and end up claiming less help than you are entitled to, the difference will be refunded to you when you file your income taxes the following year.
What happens if I underestimate my income for Obamacare in 2024?
For the 2024 tax year, if you underestimated your income and received a larger tax credit than you were eligible for, you must repay the difference between the amount of premium tax credit you received and the amount you were eligible for.
How do you get rid of share of cost in California?
Option 1: Provide proof of extra health insurance premium costs. Extra health insurance premium costs can be used to lower your countable income and may help you get rid of your share of cost. Some examples of extra health insurance premium costs are dental and vision plans, or Medicare Part D prescription plans.
How can I avoid paying back my premium tax credit?
Report any changes in your income during the year to the Marketplace, so your credit can be adjusted and you can avoid any significant repayments at the end of the year.
Can I refuse health insurance from my employer and get Obamacare?
Obamacare is available to everyone, whether or not their employers offer insurance. From a practical standpoint, though, there are financial consequences to doing this. Often, an employer subsidizes part or all of their employees' coverage.
Who qualifies for Obamacare in 2024?
Using 2024 federal poverty levels, a family of four would qualify for subsidies with a household income of $31,200 to $124,800 or more. A single person would qualify for subsidies if they made $15,060 to $60,240 or more. (Federal poverty level amounts are higher in Alaska and Hawaii.)
Who is not eligible for Obamacare?
Must live in the United States. Must be a U.S. citizen or national (or be lawfully present). Learn about eligible immigration statuses. Cannot be incarcerated in prison or jail.
How much is Obamacare a month for a single person?
Monthly premiums for Affordable Care Act (ACA) Marketplace plans vary by state and can be reduced by premium tax credits. The average national monthly health insurance cost for one person on an Affordable Care Act (ACA) plan without premium tax credits in 2024 is $477.
What does silver CSR mean?
A discount that lowers the amount you have to pay for deductibles, copayments, and coinsurance. In the Health Insurance Marketplace ®, cost-sharing reductions are often called “extra savings.” If you qualify, you must enroll in a plan in the Silver category to get the extra savings.
What does social security extra help pay for?
The Extra Help program helps with the cost of your prescription drugs, like deductibles and copays. You can apply for Extra Help any time before or after you enroll in Part D.
Who gets the benefit of a subsidy?
A subsidy given to an individual, business, or institution—usually by the government—can be direct or indirect. They can assist struggling industries, encourage new developments, and promote a social good or policy.
What is the income limit for low income subsidy?
It is also known as the Part D Low-Income Subsidy (LIS). If your monthly income is up to $1,976 in 2025 ($2,664 for couples) and your assets are below specified limits, you may be eligible for Extra Help (see the Extra Help income and asset limit chart for details).