Cost-Sharing Reductions: Why the Silver Plan Can Beat Gold and Bronze
Some of the best deals in the ACA Marketplace are the least known. If your household income is modest, a silver plan can offer coverage that rivals a platinum plan, at a silver price. The mechanism is called cost-sharing reductions (CSRs). This guide explains who qualifies, how much the plan improves, and why picking the wrong metal level could cost you thousands.
What cost-sharing reductions are
CSRs are discounts built into silver-tier plans sold on the Marketplace. They reduce your deductible, copays, coinsurance and out-of-pocket maximum. They are different from the premium tax credit, which lowers your monthly premium. You can have both, and both are applied on the Marketplace when you enroll.
Who qualifies
To get CSRs you must:
- Have household income between 100% and 250% of the federal poverty line (for a household that is lawfully present and below 100%, special rules apply);
- Be eligible for the premium tax credit, meaning in general that you do not have an affordable offer of employer coverage and are not eligible for Medicaid;
- Enroll in a silver plan through the Marketplace; and
- Not be in a plan bought outside the Marketplace. Plans bought directly from an insurer do not have CSRs applied.
For 2027 coverage, 250% of the poverty line is $39,900 for a single person and $82,500 for a family of four (using the 2026 guidelines). Members of federally recognized tribes and Alaska Native shareholders can get additional cost-sharing help at higher income levels.
The three levels of help
| Income, % of poverty line | Plan pays on average | Compared with standard |
|---|---|---|
| Up to 150% | 94% | Like a platinum plan |
| 150% to 200% | 87% | Better than gold |
| 200% to 250% | 73% | Slightly better than standard silver |
| Above 250% | 70% | Standard silver |
“Actuarial value” is the share of average costs the plan pays for a standard population. A silver plan with the 94% variant often has a deductible of a few hundred dollars (or even less) and a much lower out-of-pocket maximum than a regular silver plan. The out-of-pocket maximum on these plans is also lower than the standard limit, with the lowest limits for the lowest incomes. CMS publishes the exact reduced limits each year, and each plan lists its own.
Why a silver may beat gold or bronze
Premium tax credits are tied to the benchmark silver plan. A gold or bronze plan can cost less or more than silver after the credit, depending on your area. Insurers have historically priced silver plans higher to cover the cost of CSRs, a practice called silver loading. A larger benchmark means a bigger credit, which can make a gold plan cheaper than silver in some areas. But for households that qualify for CSRs, the silver plan upgrade also gives you the lower deductible and out-of-pocket limit. That means a person at 180% of poverty may have the choice between a CSR silver plan with a $500 deductible and a bronze plan with a $7,000 deductible, at monthly premiums that may differ by $30 to $100. For anyone expecting medical care, the silver choice can save thousands.
An example
Dana is single and expects an income of $28,000 for 2027 (about 175% of the poverty line). She is considering two plans: a bronze plan at $20 a month after her credit, with a $7,500 deductible; and a CSR silver plan at $75 a month with a $800 deductible and a $3,000 out-of-pocket maximum. If Dana has a year with $6,000 in medical bills, the bronze plan costs her about $240 in premiums plus $6,000 in bills = $6,240. The silver plan costs $900 in premiums plus about $800 + 13% of the rest, around $1,470 in total cost sharing, for $2,370 total. Even if she had no care at all, the extra premium is $660. The silver plan wins as soon as her bills are above about $1,600, and in a catastrophic year the difference after premiums is about $3,800 in her favor. This is the kind of comparison the plan comparison calculator is designed to make easily.
Traps to avoid
- Choosing a bronze plan because the premium is $0. A bronze plan at $0 is attractive, but it will have high cost sharing, which can mean you avoid needed care.
- Buying outside the Marketplace. If you go straight to an insurer or broker site that is not connected to the Marketplace, you may not get the credit or CSRs.
- Income changes. If your final income is over 250%, you do not have to repay CSRs, but if your income is too high at the time of enrollment you will not get them. If your income falls, you can update your application. Keep your income estimate current.
- Looking only at the plan name. The 94%, 87% and 73% variants are separate plans with their own cost sharing. Make sure the one you click is the one for your income level, which the Marketplace shows.
- HSA. A CSR silver plan is generally not an HSA-eligible HDHP. If an HSA matters to you, it is a trade-off.
Check the rules each year
CSR funding and rules have been the subject of litigation and legislation. At the time of writing, CSRs are required in silver plans for eligible households in plan year 2027. Check HealthCare.gov for the current rule if Congress changes it.
How to confirm you are getting the CSR version
When you apply through the Marketplace and report income between 100% and 250% of poverty, the plan results should mark the silver plans with a label that identifies the CSR variant, such as “94% AV”, “87% AV” or “73% AV”, or they may show only a lower deductible. Open the plan details and compare the deductible and out-of-pocket maximum to the same insurer’s regular silver plan. After enrolling, check your confirmation to be sure that the variant is the one shown. If your income estimate changes during the year, the Marketplace may move you to a different variant, and the new plan may start counting your deductible again, though insurers are required to credit costs you have already paid in many cases. Ask your insurer about this if you change income during the year.