Lower-income taxpayers who qualify for the premium assistance tax credit will also be eligible for cost sharing assistance if they enroll in a silver plan. This assistance will limit the plan’s maximum out-of-pocket costs, and for some will also reduce other cost sharing amounts, such as deductibles, coinsurance or copayments, that would be charged to them by their insurance plan.
The maximum limit for out-of-pocket expenses depends on income and coverage type. See the table below for the maximum amounts.
Lower-income cap on out-of-pocket expenses – In addition, federal payments will be made to health insurers to increase the actuarial value of the plan for people with incomes under 250% of the federal poverty level. For example, for people with incomes between 100% and 150% of the federal poverty level, the actuarial value of the plan will be increased to 94%. That means that in addition to keeping within the lower out-of-pocket maximums established above, insurers must make other changes to increase the actuarial value of the coverage. This will likely mean reduced plan deductibles, coinsurance or copayments in order to meet the higher actuarial value requirements.
|Cap on out-of-
|133% < 150%||6%|
|150% < 200%||13%|
|200% < 250%||27%|