Do You Qualify for Lower Out-of-Pocket Costs in the Marketplace?

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 income.

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.

This savings is based on your income and family size.   Savings depend on your income

Health insurance companies offering coverage through the Marketplace must lower the amount you pay out of pocket for essential health benefits if your household income is below the following amounts. (Incomes below are based on 2013 numbers. They are likely to be slightly higher in 2014. Amounts are different for each family size, up to 8.)

Up to $28,725 for individuals         /         Up to $38,775 for a family of 2    

Up to $48,825 for a family of 3      /          Up to $58,875 for a family of 4

Up to $68,925 for a family of 5      /          Up to $78,975 for a family of 6

Up to $89,025 for a family of 7      /          Up to $99,075 for a family of 8

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

Out-of-pocket savings apply only to Silver plans

Plans in the Marketplace are separated into 4 different categories: Bronze, Silver, Gold, and Platinum. These categories are based on how much of your medical costs 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. If you qualify for these savings, you’ll get the out-of-pocket savings benefits of a Gold or Platinum plan for a Silver plan price. You can choose any category of plan, but you’ll get the out-of-pocket savings only if you enroll in a Silver plan.

You’ll be able to choose your plan category when you fill out your Marketplace application.

Until October 1, you can get a rough estimate of costs and savings by using the Kaiser Family Foundation calculator.