Quick answer
Cost-sharing reductions are extra Marketplace savings that lower your deductible, copays and out-of-pocket maximum. You get them only on a silver plan bought through the Marketplace, and only if your household income is between 100% and 250% of the poverty level, which is $15,960 to $39,900 for one person for 2027 coverage. At the lowest incomes, a silver plan pays about 94% of average costs instead of the usual 70%.
Key takeaways
- There are three levels: a silver plan pays about 94% of average costs from 100% to 150% of the poverty level, 87% from 150% to 200% and 73% from 200% to 250%.
- For 2027, the out-of-pocket maximum drops from $12,000 to $4,000 for one person with income up to 200% of the poverty level, and to $9,600 from 200% to 250%.
- In 2026, the average benchmark silver deductible fell from $5,304 to $80 for people under 150% of the poverty level and to $790 for those from 150% to 200%.
- Insurers add the cost of these reductions to silver premiums, so gold plans sometimes cost less than silver, but only silver comes with the extra savings.
- Cost-sharing reductions aren’t paid back at tax time, even if your income ends up higher than you expected.
On this page
How cost-sharing reductions work
A premium tax credit lowers your monthly premium. Cost-sharing reductions lower what you pay when you use care: the deductible, copays, coinsurance and the out-of-pocket maximum. Both are forms of Marketplace subsidy, and you can get both at once.
The savings are built into the plan. When you qualify and pick a silver plan, you get a version of that plan with lower cost-sharing at the same premium as the standard silver plan. To qualify, you have to be eligible for a premium tax credit, expect household income of 100% to 250% of the poverty level, and enroll through the Marketplace. Your eligibility notice will say whether you qualify.
The three levels for 2027
| Your income | Silver plan pays on average | 2027 out-of-pocket maximum, one person | Family maximum |
|---|---|---|---|
| 100% to 150% of poverty | 94% | $4,000 | $8,000 |
| Above 150% to 200% | 87% | $4,000 | $8,000 |
| Above 200% to 250% | 73% | $9,600 | $19,200 |
| Above 250% (regular silver) | 70% | $12,000 | $24,000 |
Here’s what those income levels mean in dollars for 2027 coverage:
| Household size | 94% level | 87% level | 73% level |
|---|---|---|---|
| 1 | $15,960 to $23,940 | $23,941 to $31,920 | $31,921 to $39,900 |
| 2 | $21,640 to $32,460 | $32,461 to $43,280 | $43,281 to $54,100 |
| 3 | $27,320 to $40,980 | $40,981 to $54,640 | $54,641 to $68,300 |
| 4 | $33,000 to $49,500 | $49,501 to $66,000 | $66,001 to $82,500 |
In states that expanded Medicaid, adults under 138% of the poverty level ($22,025 for one person) usually qualify for Medicaid instead, so the 94% level starts above that line. To check which column your income falls in, see what counts as income for Marketplace coverage.
How much lower your costs can be
The drop is biggest at the lowest incomes. Peterson-KFF found that in 2026 the average deductible for a benchmark silver plan was $5,304. With cost-sharing reductions, it averaged $80 for people under 150% of the poverty level, $790 from 150% to 200% and $3,727 from 200% to 250%.
Copays, coinsurance and the out-of-pocket maximum come down too. The 73% level is a much smaller step up from a regular 70% silver plan, so people from 200% to 250% of the poverty level have more reason to compare silver against bronze and gold.
Why it has to be a silver plan
Federal rules allow cost-sharing reductions only on silver plans bought through the Marketplace, with an exception for American Indians and Alaska Natives. If you pick bronze or gold, you keep your premium tax credit but give up the lower deductible and copays.
Many eligible people pick bronze anyway, usually for its lower premium. KFF found that among people eligible for cost-sharing reductions in HealthCare.gov states, the share choosing a silver plan with them fell from 66% in 2025 to 45% in 2026. If you’re in bronze and qualify, auto-renewal will keep you in bronze for 2027, so you’d have to switch yourself; see whether to let your plan auto-renew. For a refresher on tiers, see bronze, silver, gold and platinum plans.
Why gold can cost less than silver
The federal government stopped paying insurers for cost-sharing reductions in October 2017. Most insurers responded by adding that cost to their silver premiums, which is called silver loading. Because the premium tax credit is pegged to the benchmark silver plan, higher silver prices mean bigger tax credits, and those credits can make bronze and gold plans much cheaper after the credit. In some areas, gold plans are priced below silver; Texas is one state where this happens, as our Texas cost guide explains.
If you qualify for the 94% or 87% level, a silver plan’s lower deductible often beats a cheaper gold premium. At the 73% level, a low-priced gold plan may come out ahead. Compare the premium plus the costs you’d expect to pay for care.
Extra protections for American Indians and Alaska Natives
Members of federally recognized tribes and Alaska Native Claims Settlement Act (ANCSA) shareholders with income from 100% to 300% of the poverty level, or $15,960 to $47,880 for one person for 2027, can get a zero cost-sharing plan with no deductible, copays or coinsurance. They can get these savings with any metal level, not only silver. At any income, care from an Indian health care provider comes with no out-of-pocket costs. Tribal members and ANCSA shareholders can also enroll any time of year and change plans up to once a month, with a document showing membership or shareholder status.
Do you have to pay them back?
No. Cost-sharing reductions aren’t reconciled on your tax return, so you keep what you saved even if your income ends up above 250% of the poverty level. Your premium tax credit is different: it’s settled against your actual income, and since 2026 there’s no cap on repaying extra credit. See paying back the premium tax credit. If your income changes during the year, report it, because it can change your savings level.
See silver plans with cost-sharing reductions in your area: compare 2027 plans by ZIP code.
Frequently asked questions
Who qualifies for cost-sharing reductions?
People who qualify for a premium tax credit, expect income from 100% to 250% of the poverty level and enroll in a silver plan through the Marketplace. For 2027 coverage, that’s $15,960 to $39,900 for one person or $33,000 to $82,500 for a family of four.
Can I get cost-sharing reductions with a bronze or gold plan?
No, unless you’re a member of a federally recognized tribe or an ANCSA shareholder, who can get them with any metal level.
Do cost-sharing reductions lower my premium?
No. They lower your deductible, copays and out-of-pocket maximum. The premium tax credit is what lowers your monthly premium.
Sources
- HealthCare.gov: Cost-sharing reductions
- CMS: Premium adjustment percentage and maximum annual limitation on cost sharing for 2027 (PDF)
- Peterson-KFF Health System Tracker: Higher premium payments or higher deductibles?
- KFF: Explaining cost-sharing reductions and silver loading in ACA Marketplaces
- HealthCare.gov: Health coverage for American Indians and Alaska Natives
- KFF: Will I have to pay back cost-sharing subsidies if I earn more than 250% of poverty?
This article is general information, not insurance, tax or legal advice. Deductibles and copays differ from plan to plan, so check each silver plan’s details before you enroll. Last reviewed October 2026.