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How do Subsidies like Cost-Sharing Reductions Work?

Cost-Sharing Reductions are only available to those who qualify. Again, they do not apply to Grandfathered Plans. If you qualify, you will want to take advantage of both Cost-Sharing Reductions and Advanced Premium Tax Credits. You can use them both to maximize your savings.Cost-Sharing Reductions are only available to individuals who are ineligible for public coverage and are unable to get qualified health insurance through an employer.


2014 plans will be grouped into four metallic levels: Bronze, Silver, Gold and Platinum. In order to take advantage of Cost-Sharing Reductions, you must choose a Silver plan. They help lower out-of-pocket expenses, such as deductibles, co-pays and coinsurance.

Cost-Sharing Reductions are only available for households with incomes thatare between 100% and 250% of the Federal Poverty Level (FPL).

For example, let’s say you go to the doctor and are charged $100. Normally with a Silver plan you might have a co-pay of $25, but because
you qualify for Cost-Sharing Reductions and you chose a Silver plan, you may have a co-pay as low as $5.

Cost-Sharing Reductions can also lower deductibles. For example, a $3,500 deductible may be lowered to $500.

With Cost-Sharing Reductions, you essentially pay for a Silver plan but receive the richer coverage of higher metallic level plans, thereby reducing your out-of-pocket expenses. If you qualify for Cost-Sharing Reductions, you should take advantage of this cost savings benefit.

For more information on health insurance coverage in North Carolina, please visit our website at or call our toll free number 888-765-5400 and speak with one of our professional agents. Our agency provides coverage for health insurance in North Carolina through Blue Cross Blue Shield of North Carolina (BCBSNC). You may qualify for a 15% healthy lifestyle discount if you are in excellent health. Call us for details.

Information from a BCBSNC publication on 8/12/13.

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