Understanding Cost Sharing Reductions
Don’t miss out on savings if you qualify
If you enroll in a Qualified Health Plan (QHP) through Access Health CT, there are two types of financial help you may qualify for:
1. Premium Tax Credits: reduce your monthly payments (premium). More here.
2. Cost-Sharing Reductions: reduce what you pay out of your own pocket when you use your health insurance plan
More about Cost-Sharing Reductions
Cost-sharing Reductions, also known as CSRs, lower the amount you pay out-of-pocket for things like deductibles, co-insurance and co-payments when you get medical services. If you qualify for CSRs, you must enroll in a Silver level plan to get these lower costs.
What does this mean?
This means that if you choose a Silver Plan you may pay less for Doctor and Hospital Visits, and Prescription Drugs.
Remind me what a Silver level plan is?
Plans in the Silver level may provide lower monthly premiums (payments) but offer more coverage right away when you need to use your plan. Many Silver Plans may not require you to meet a deductible first before getting coverage for many services unlike plans at the Bronze level. More information is found below.
So, in summary…
If you are eligible for Cost Sharing Reductions, you need to choose a plan at the Silver level to take advantage of this type of financial help. Once you enroll, you will have access to reduced out-of-pocket costs for services when you use your plan.
How do people qualify for Cost-Sharing Reductions?
During your enrollment process you will include basic personal information – like estimated Modified Adjusted Gross Income or MAGI, address and age to determine if you qualify for financial help or are eligible for low-cost or free coverage. And if you are determined to be eligible for Cost Sharing Reductions, you will need to select a plan at the Silver level to take advantage of this type of financial help. Once you enroll, you will have access to reduced out-of-pocket costs for services when you use your plan.
What if I qualify for CSRs and enrolled in a plan that is not a Silver?
If you enroll in a plan–like a Bronze or Gold plan– you will not be able to access these reduced out-of-pocket costs. But if you enroll through Access Health CT and you qualify for a Cost Sharing Reduction Plan during the Annual Open Enrollment Period (November 1 to December 15), you can switch to a Silver Plan instead and see some extra savings.
More information about Plan Options
Available Through Access Health CT
Short & Simple:
– Bronze Plans: Sometimes have the lowest monthly payments, higher costs when you get care
– Silver Plans: Sometimes have moderate monthly payments, moderate costs when you get care
– Gold Plans: Sometimes have higher monthly payments, but lower costs when you get
Want More Detail?
Here it is.
• Bronze Plans — may have lower monthly premium payments but may require you
to meet high deductibles before the plan starts paying for the services you receive. This means bronze plans may be cheaper to have, but more expensive to use.
• Silver Plans — may offer moderate monthly premium (payments) costs.
Some services are covered with a copay or coinsurance right away when you use your Silver plan. Silver plans through Access Health CT also have separate, much smaller deductibles for prescription drugs which can provide you with greater access to these benefits.
• Gold Plans — may offer greater coverage but may come with a higher monthly premium (payment) costs.
Many Gold plans have low deductibles and often, low out-of-pockets costs when you receive care.
Ready to look at your options to decide whether to switch to a Silver Plan?
All Help Is Free
• If you have a broker contact them as soon as possible to discuss your plan options
• Don’t have a Broker? Find one here.
• Call us at: 1-855-805-4325 (TTY 1-855-789-2428)