Cost‑Sharing Reductions (CSRs): Lower out-of-pocket costs with Silver plans

Extra savings that reduce what you pay when you get care – not just what you pay each month.

Page last updated on: 4/21/26

Cost‑Sharing Reductions (CSRs) are savings that can lower what you pay out of pocket for health care – things like deductibles, copays, and coinsurance. If you qualify and enroll in an eligible Silver plan, CSRs can make care more affordable when you need it.

Priority Health checks whether you qualify and helps you enroll in a plan that includes these savings.

Good to know: CSRs are different from Premium Tax Credits (PTCs).

  • PTCs help lower your monthly premium
  • CSRs lower your costs when you use care

What are Cost‑Sharing Reductions (CSRs)?

Cost‑Sharing Reductions are a savings benefit that lowers your out‑of‑pocket costs for covered services if you qualify. With CSRs, your plan may include:

  • A lower deductible
  • Lower copays
  • Lower coinsurance
  • A lower out‑of‑pocket maximum (the most you’d pay in a year for covered services)

CSRs don’t change your monthly premium directly; they change what you pay when you use your benefits.

How CSRs work

Think of CSRs as a “boost” to your Silver plan’s cost‑sharing:

  1. You apply for coverage through Priority Health or the Marketplace during Open Enrollment or, if you qualify, a Special Enrollment Period.
  2. Eligibility for Cost‑Sharing Reduction (CSR) savings is determined during the application process based on household and income information provided.
  3. If you qualify and choose an eligible Silver plan, your plan is designed so you pay less out of pocket when you receive care.

CSRs and Silver plans

Cost‑Sharing Reductions are available with eligible Silver health plans.

If you qualify for CSRs and choose a Silver plan:

  • Your deductible may be lower
  • Copays and coinsurance may be reduced
  • Your out‑of‑pocket maximum may be lower than a standard Silver plan

If you don’t enroll in a Silver plan, these specific CSR savings typically don’t apply – even if you qualify.

CSRs vs. Premium Tax Credits (PTCs)

CSRs and PTCs are often mentioned together, but they do different things.

Premium Tax Credits (PTCs)

  • Help lower your monthly premium
  • Reduce the cost of having coverage

Cost‑Sharing Reductions (CSRs)

  • Lower what you pay when you receive care
  • Reduce deductibles, copays, and coinsurance
  • Apply to eligible Silver plans

Many people qualify for both, meaning they pay less each month and less when they use care.

Who should pay close attention to CSRs?

CSRs can be especially helpful if you:

  • Expect to use health care during the year
  • Want more predictable costs when you visit a doctor or fill prescriptions
  • Want protection from higher bills in case of an unexpected illness or injury

For many people who qualify, a Silver plan with CSRs can be a strong option, balancing monthly cost with lower out‑of‑pocket expenses.

How Priority Health helps

You don’t need to figure this out on your own. When you apply:

  • Priority Health checks if you qualify for Cost‑Sharing Reductions
  • You can compare Silver plan options that may include CSR savings
  • You’ll see how deductibles, copays and out‑of‑pocket costs differ between plans

This makes it easier to choose a plan that fits both your budget and your expected care needs.

How to compare plans if you qualify for CSRs

When reviewing Silver plan options, look beyond the monthly premium and compare:

  • Deductible: What you pay before many services are covered
  • Copays and coinsurance: What you pay for visits, tests and care
  • Out‑of‑pocket maximum: Your yearly cap on covered costs
  • Provider network: Whether your doctors and hospitals are included
  • Prescription coverage: How medications are covered and what they cost

CSR‑eligible Silver plans often have lower out‑of‑pocket costs than standard Silver plans.

No. CSRs lower what you pay when you use care. Premium Tax Credits are what lower monthly premiums.

Yes. Priority Health checks whether you qualify for CSR savings as part of the application and enrollment process.

CSRs lower deductibles, copays, coinsurance, and often the out‑of‑pocket maximum for covered services. 

Learn more about these health insurance terms.

Yes. Cost‑Sharing Reductions apply to eligible Silver plans.

Federal poverty guidelines are determined every year by the Department of Health and Human Services (HHS). They determine eligibility for many programs, including premium tax credits (PTC) and cost-sharing reductions (CSRs) for Marketplace plans.

To be eligible for a PTC, your household income must be between 100% and 400% of the federal poverty level. You may also be eligible for CSRs if your income is up to 250% of the federal poverty level.

Since the amount of a PTC is based on a sliding scale, it's best to check if you qualify for a subsidy.

Here are the 2025 federal poverty guidelines for coverage year 2026. Use your household's adjusted gross income.

 

Persons in family/household100% poverty guideline250% poverty guideline400% poverty guideline
1$15,650$39,125$62,600
2$21,150$52,875$84,600
3$26,650$66,625$106,600
4$32,150$80,375$128,600
5$37,650$94,125$150,600
6$43,150$107,875$172,600
7$48,650$121,625$194,600
8$54,150$135,375$216,6000

For families/households with more than 8 persons, add $5,500 for each additional person.

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