Cost-sharing
Cost-sharing reduction (CSR)
A subsidy under the ACA that lowers deductibles, copays, and coinsurance for marketplace Silver-tier plans for households earning between 100% and 250% of the federal poverty level (FPL). Only available on Silver plans purchased through Healthcare.gov or a state exchange.Last reviewed: · TMRW Benefits is a benefits brokerage, not a tax or legal advisor. Consult a CPA or attorney for situation-specific guidance.
Related terms
ACA (Affordable Care Act)
2010 federal law restructuring U.S. health insurance markets.
Read definitionFPL (Federal Poverty Level)
Federal income threshold defining poverty.
Read definitionPremium tax credit (PTC)
ACA subsidy reducing marketplace premiums for 100-400% FPL.
Read definitionMarketplace
ACA exchange where individuals shop for plans.
Read definitionMore in Cost-sharing
Premium
Monthly payment to keep coverage active.
Deductible
Out-of-pocket amount you pay before insurance starts paying.
Copay
Flat fee per service. Often not subject to the deductible.
Coinsurance
Percentage of cost you pay after deductible.
Out-of-pocket maximum (OOP max)
Annual cap on your covered in-network costs.
Allowed amount
Maximum the plan considers reasonable for a service.
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