Cost Sharing Reduction

Acronym: CSR

Is a provision of the Affordable Care Act that reduces out-of-pocket costs for eligible enrollees who select Silver health insurance plans in the marketplace. CSRs – often referred to as cost-sharing subsidies – reduce enrollees’ cost-sharing by lowering a health plan’s out-of-pocket maximum and increasing the actuarial value (AV) of the plan. Cost-sharing reductions are available to eligible enrollees who select Silver plans in the Marketplace. Eligible enrollees have household incomes up to 250% of the federal poverty level (FPL). The lower income threshold for CSR is 100% of the poverty level in states that have not expanded Medicaid, and 139% of FPL in states that have expanded Medicaid. (If you’re eligible for Medicaid, you’re not eligible for any sort of subsidies in the exchange; note that the lower income limits do not apply to recent immigrants, as they are generally not eligible for Medicaid until they’ve been in the U.S. for at least five years.) When an enrollee who is eligible for CSR applies for a Silver plan, they are enrolled into a Silver plan that has cost-sharing reductions automatically built into the plan design. So the lower out-of-pocket cap and higher AV are automatic, as long as the person picks a Silver plan.