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The Cost Sharing Reductions (CSR) reduce the amount that a consumer has to pay out of pocket for care, thereby making the insurance plans more affordable. Under Obamacare, those who qualify for these CSR discounts will see lower out of pocket costs associated when applying to Silver plans they are eligible for on the marketplaces. The copays, coinsurance and deductibles associated with these plans will be reduced, effectively making the insurance carriers share of financial responsibility higher than it would otherwise.

Who Qualifies For Cost Sharing Reductions?

While the tax credit subsidies are applicable to households making up to 400% of the federal poverty level (FPL), the CSR discounts are available only to households of up to 250% of the FPL. The amount of your discount will depend on which bucket your income places you in. The lower your income bucket the more of the expenses the insurance carrier will pick up through the plan, and the lower your out of pocket cost sharing fees. The Cost Sharing reductions increase the Actuarial Value of a health insurance plan, by forcing an insurer to pick up a higher proportion of the costs.
The AV of a plan is the percentage of total healthcare costs that a plan will end up covering on average. With an AV of 70%, a consumer enrolled in a Silver plan would be expected to pay on average 30% of the actual healthcare costs they incurred with the company picking up the rest. Since these Actuarial values are based upon the average enrollees, the actual percentages for any individual household will vary significantly based upon their total healthcare costs. In general the lower your expected healthcare costs the lower the AV value will be since you are responsible for the deductibles before the insurer picks up any part of the bill.


Obamacare / ACA Cost Sharing Reductions


The Affordable Care Act / Obamacare makes health insurance affordable in two ways. The first is through advanced tax credit subsidies that reduce the premiums you pay for a particular plan based on your income level. While most media coverage is focused on these premiums, the out of pocket costs in terms of deductibles, copays, coinsurance and out of pocket maximums are just as important when it comes to the cost of your coverage.
The Affordable Care Act also makes plans more affordable by reducing these cost sharing mechanisms through cost sharing reduction subsidies. 

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