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Most people shopping on the health insurance marketplace know about the premium tax credit. It lowers your monthly bill, and it gets all the attention. There is a second discount that works on a completely different part of your costs, and it goes unnoticed by a lot of shoppers: cost-sharing reductions.
Cost-sharing reductions, usually called CSRs, shrink what you pay when you actually get care. Lower deductibles, lower copays, a lower out-of-pocket maximum. The catch is that they only work on Silver plans, and only for households in a specific income range.
Who qualifies for cost-sharing reductions
You qualify for CSRs if your household income falls between 100% and 250% of the federal poverty level and you enroll in a Silver marketplace plan. Using the 2026 poverty guidelines, that works out to:
- Single person: $15,960 to $39,900 per year
- Family of four: $33,000 to $82,500 per year
These are the same income bands used for 2027 marketplace coverage, since the marketplace prices next year’s plans using the current year’s poverty figures. There is no separate application. When you enroll in a Silver plan and your income qualifies, the CSR version of the plan is what you get.
The three CSR tiers
Not everyone in the range gets the same deal. The reduction comes in three levels, based on income:
- 100% to 150% of the poverty level: your Silver plan covers about 94% of average costs, roughly Platinum-level coverage.
- 150% to 200% of the poverty level: about 87% of average costs.
- 200% to 250% of the poverty level: about 73% of average costs.
A standard Silver plan covers about 70% of average costs. So at the lowest income band, CSRs turn a Silver plan into something that behaves like a Platinum plan, while you pay a Silver premium.
What changes on the actual plan
The insurer takes its standard Silver plan and produces a CSR variant with the same doctors, the same hospitals, the same covered benefits, and the same network. What changes are the cost-sharing numbers: the deductible drops, copays drop, and the out-of-pocket maximum drops.
For 2027 coverage, the standard out-of-pocket limit is $12,000 for an individual. On a CSR Silver plan at 100% to 200% of the poverty level, that cap cannot exceed $4,000. Between 200% and 250%, it cannot exceed $9,600. That is the difference between a hospital stay that ruins your year and one you can absorb.
A worked example
Take a single person earning $22,000 a year, roughly 138% of the poverty level. She enrolls in a Silver plan. Because her income sits in the 100% to 150% band, her plan runs at 94% actuarial value. The standard Silver deductible in her area might be $4,000; her CSR version could be a few hundred dollars. A specialist visit that costs a $75 copay on the standard plan might be $20 on hers. She pays the same Silver premium, minus her premium tax credit, and gets far better coverage when she needs care.
Why people miss this
The most common way to miss CSRs is picking Bronze because the monthly premium is lower. That is understandable, and for some households it is the right call, but the math deserves a second look. If your income is under 250% of the poverty level, a Silver plan with CSRs often beats a Bronze plan on total yearly cost, because the Bronze deductible is so high that one bad month erases the premium savings. Our Bronze vs Silver total-cost comparison walks through that tradeoff.
The other way people miss CSRs is picking Gold. A Gold plan covers 80% of average costs, which sounds better than Silver’s 70%, but CSRs do not apply to Gold at all. At 100% to 200% of the poverty level, a CSR Silver plan at 87% or 94% coverage beats a standard Gold plan, usually at a lower premium.
How to get CSRs
There is no extra form and no extra waiting period. Apply through the marketplace, report your income as accurately as you can, and choose a Silver plan. If your income qualifies, the plan details shown to you are already the CSR version. If your income changes during the year, update your application, because your CSR level follows your reported income. Estimating income carefully matters here too, since overestimating can push you into a weaker CSR tier; our guide to estimating income for ACA subsidies covers the mechanics.
CSRs are the single most valuable marketplace benefit for lower-income households, and they cost nothing extra to claim. If your income lands between 100% and 250% of the poverty level, shop Silver first.
