Original painting by Sue Boswell.
Cost Sharing Reduction (CSR)
A discount that lowers the amount you have to pay for deductibles, copayments, and coinsurance. In the Health Insurance Marketplace, cost-sharing reductions are often called “extra savings.” If you qualify, you must enroll in a plan in the Silver category to get the extra savings.
• When you fill out a Marketplace application, you’ll find out if you qualify for premium tax credits and extra savings. You can use a premium tax credit for a plan in any metal category. But if you qualify for extra savings too, you’ll get those savings only if you pick a Silver plan.
• If you qualify for cost-sharing reductions, you also have a lower out-of-pocket maximum — the total amount you’d have to pay for covered medical services per year. When you reach your out-of-pocket maximum, your insurance plan covers 100% of all covered services.
• If you’re a member of a federally recognized tribe or an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder, you may qualify for additional cost-sharing reductions.
QUALIFYING EVENTS that allow you to buy insurance during the Special Enrollment Period……….
Individuals who once could buy health insurance whenever they wanted are now forced to act like traditional company employees, and only enroll in a health insurance plan during an annual open enrollment period. However, life can throw curve balls, and leave an individual without health insurance outside of the open enrollment period. Then what?
The structure of the Affordable Care Act doesn’t leave these individuals without coverage. Anyone with qualifying life events can enroll in a healthcare plan outside of the open enrollment period. These special life circumstances include:
• Losing your employer insurance coverage
• Having COBRA coverage expire
• Getting married
• Getting divorced
• Having a baby (or adopting a child)
• Moving to a new ZIP code
• Turning 26 and losing coverage through a parent’s plan
• Gaining U.S. citizenship
• Leaving incarceration
• Losing Medicaid or CHIP status
• Being discharged from the Armed Forces
• Gaining status as a member of a Native American tribe or Alaskan native
It is critical to know that you must enroll in an individual plan within 60 days of losing coverage. If you fail to meet the deadline, you will not be allowed to purchase health insurance and could suffer paying a fine for failing to comply with the Affordable Care Act mandate that states all Americans must have health insurance coverage for a minimum of nine months of the year. The fine would be paid along with any federal taxes you might owe. If you typically receive a refund, the total amount of the fine will be withheld from your refund dollars.