Key Takeaways
- Cost sharing reductions (CSRs) only come with silver plans bought on the Marketplace.
- For 2027 coverage, a single adult qualifies with income up to about $39,900.
- The lowest-income tier gets a silver plan that works like a platinum plan.
- In 2027, the out-of-pocket maximum can drop from $12,000 to $4,000 for one person.
- Unlike tax credits, cost sharing reductions are never repaid at tax time.
In This Guide
How Cost Sharing Reductions Work
Every plan splits costs between you and the insurer. Your share includes the deductible, copays, coinsurance and the out-of-pocket maximum. Cost sharing reductions shrink that share, so the plan pays more of each bill. Insurers measure this with actuarial value. A regular silver plan pays about 70% of average costs. With extra savings, the same silver plan pays 73%, 87% or 94%, depending on your income. Two other points matter. First, the savings are built into the plan, so there is no separate check or form. Second, they work alongside premium tax credits, which lower your monthly bill. Our guide to health insurance subsidies explains how those tax credits are figured.Cost Sharing Reductions Income Limits for 2027 Coverage
For plans that start in 2027, the Marketplace uses the 2026 poverty guidelines. Here is the income range by household size in the lower 48 states.| Household size | 100% of poverty level | 200% of poverty level | 250% of poverty level |
|---|---|---|---|
| 1 person | $15,960 | $31,920 | $39,900 |
| 2 people | $21,640 | $43,280 | $54,100 |
| 3 people | $27,320 | $54,640 | $68,300 |
| 4 people | $33,000 | $66,000 | $82,500 |
Based on 2026 federal poverty guidelines used for 2027 coverage, per healthinsurance.org. Alaska and Hawaii use higher amounts. Keep Medicaid in mind, too. In states that expanded Medicaid, adults under 138% of the poverty level usually get Medicaid instead. So in those states, extra savings start just above that line. You also need to qualify for a premium tax credit. That means no affordable job-based coverage and no Medicaid eligibility. Earn more than 400% of the poverty level? Then you face the ACA subsidy cliff, with no tax credit at all.
The Three Levels of Cost Sharing Reductions
Savings come in three steps. The lower your income, the richer your silver plan becomes.| Income (% of poverty level) | Plan pays on average | 2027 out-of-pocket max (single / family) |
|---|---|---|
| Regular silver, no extra savings | About 70% | $12,000 / $24,000 |
| 100% to 150% | 94% | $4,000 / $8,000 |
| 150% to 200% | 87% | $4,000 / $8,000 |
| 200% to 250% | 73% | $9,600 / $19,200 |
Out-of-pocket limits from healthinsurance.org. Each insurer sets its own deductibles and copays within these limits. In practice, the 94% tier works like a platinum plan for a silver price. The 87% tier lands between gold and platinum. Meanwhile, the 73% tier is a modest bump, so compare it closely with bronze. To see how these limits work, read what an out-of-pocket maximum is. Native Americans and Alaska Natives get even more help. With income under 300% of the poverty level, they can choose plans with no cost sharing at all.
See Your Silver Plan Extra SavingsA licensed Vivna agent can check your income tier and compare silver plans side by side at no cost. Call 888-730-6031 or request a free quote online.
Silver vs. Bronze When You Qualify for Cost Sharing Reductions
Bronze plans often cost less each month, and sometimes nothing after tax credits. Even so, a cheap bronze plan can carry a deductible of several thousand dollars. If you qualify for the 94% or 87% tier, silver usually gives far more value. Many families have chosen bronze since the larger tax credits ended. In North Carolina, for example, the share of enrollees with extra savings fell from 45% to 28% in 2026. Over the same time, bronze picks jumped from 45% to 64%, per healthinsurance.org. That trade-off can backfire after one hospital visit. So before you switch, price out a bad year on each plan. Our guides to bronze vs. silver plans and bronze, silver and gold plans show the math. On top of that, silver premiums include a hidden boost. Insurers stopped getting federal cost sharing payments in 2017, so most add that cost to silver prices. Because tax credits follow the benchmark silver price, credits grow too. As a result, some gold and bronze plans look cheaper than you might expect.How to Get Cost Sharing Reductions, Step by Step
- Estimate your income for the coverage year. Use expected household income, not last year's tax return alone.
- Apply on HealthCare.gov or with a licensed agent. The application tells you if you qualify for extra savings.
- Pick a silver plan. Bronze, gold and platinum plans do not carry these savings.
- Check the plan's deductible and copays. Each insurer builds its extra-savings plans differently.
- Confirm your doctors and drugs. A low deductible helps only if your care is in network.
- Report income changes during the year. Your savings level can rise or fall with your income.
Cost Sharing Reductions FAQs
Do I have to pay back cost sharing reductions?
No. Extra savings are never repaid at tax time. However, excess premium tax credits can be, so keep your income estimate accurate.Can I get cost sharing reductions on a bronze or gold plan?
No. Extra savings only come with silver plans bought through HealthCare.gov or your state's exchange.What is the income limit for cost sharing reductions in 2027?
The limit is 250% of the poverty level. For 2027 coverage, that is $39,900 for one person and $82,500 for a family of four.Are cost sharing reductions going away?
No. They remain part of the ACA for 2027. Congress has debated funding the insurer payments again, but no change has passed.Does a cost sharing reduction plan have a different network?
No. Your silver plan keeps the same network. Only your deductible, copays and out-of-pocket maximum change.Next Steps
First, compare your income with the table above. Next, look at silver plans before you default to bronze. Finally, let a licensed agent confirm your tier and your network. Call 888-730-6031 to compare plans today.Sources
- healthinsurance.org: The ACA's cost-sharing subsidies
- HealthCare.gov: Cost-sharing reductions
- healthinsurance.org: North Carolina marketplace
Related Guides
- Open enrollment health insurance guide
- Health insurance subsidies
- ACA subsidy cliff
- Bronze vs. silver plan
- Special enrollment period
About the author: Heather Sprague
Heather is the owner and agent of record at Vivna Insurance, a licensed independent agency in Deerfield Beach, Florida. She helps families and self-employed workers compare marketplace, short-term and supplemental plans.
Licensed health insurance agent, Vivna Insurance (Agency NPN 19168641). Call 888-730-6031.
Reviewed by Michael Sprague, licensed health insurance agent.
Vivna Insurance is a licensed independent agency, not a government website, and is not HealthCare.gov. Our help is free; we are paid by the insurance companies we work with. Plan availability, rates and savings vary by county and income.
