Understanding the Cost-Sharing Reduction (CSR) Program for Affordable Care Act (ACA) Health Insurance
What is Cost-Sharing Reduction (CSR)?
The Cost-Sharing Reduction (CSR) program is a financial assistance program available under the Affordable Care Act (ACA) that helps reduce out-of-pocket healthcare costs, such as deductibles, co-pays, and coinsurance, for low- to moderate-income individuals and families.
How Do I Qualify for CSR?
To qualify for CSR, you must:
Be enrolled in a Silver plan through the Health Insurance Marketplace
Have an annual household income between 138% and 250% of the federal poverty level (FPL)
How Much Financial Assistance Do I Get?
The amount of CSR assistance you receive depends on your income and the number of people in your household. Generally, Silver plans with CSR offer the following coverage:
Bronze: Covers about 60% of costs
Silver: Covers about 70% of costs
Silver with CSR: Covers about 94% of costs
Gold: Covers about 80% of costs
Platinum: Covers about 90% of costs
How Do I Apply for CSR?
To apply for CSR, you must enroll in a Silver plan through the Health Insurance Marketplace. When you apply, provide an estimate of your income for the upcoming year. Based on your income, you may qualify for CSR assistance.
Benefits of CSR
Reduced out-of-pocket healthcare costs
Access to more affordable healthcare services
Peace of mind knowing that your healthcare costs are manageable
Considerations
If your income goes up or down significantly, you must report the change to the Health Insurance Marketplace to ensure you continue to receive the correct amount of financial assistance.
If you knowingly provide incorrect income information, you may be subject to penalties.
CSR assistance is only available for Silver plans. If you enroll in a different type of plan, you will not qualify for CSR.
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