Cost sharing assistance

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 amount of the reduction depends on income. For those with incomes between 100% and 200% of poverty, a limit of 1/3 of the 2014 health spending account out-of-pocket limit (a 2/3 reduction) applies. For 2014, this would make the out-of-pocket maximum $2,117 for individual coverage and $4,233 for a family. For others, the limit is either 1/2 or 2/3 of the HSA out-of-pocket limit, depending on income. The precise amount by which your out-of-pocket maximum is reduced by this assistance depends on the maximum for the plan in which you are enrolled.

poverty level
Portion of 2014 HSA limit* Individual
100–200% 1/3 $2,117 $4,233
201–300% 1/2 $3,175 $6,350
301–400% 2/3 $4,233 $8,467
Above 400% 100% $6,350 $12,700
*HSA out-of-pocket expenses limit

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.

poverty level
Cap on out-of-
pocket expenses
133% < 150% 6%
150% < 200% 13%
200% < 250% 27%
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