Who qualifies.
You qualify if your household income is between 100% and 250% of the poverty level, you are eligible for the premium tax credit, and you enroll in a silver plan through HealthCare.gov. You do not apply separately; HealthCare.gov applies it automatically when you pick a silver plan.
| Income band | One person, 2027 | Family of 4, 2027 | Silver plan becomes worth | 2027 out-of-pocket max (self) |
|---|---|---|---|---|
| 100% to 150% | $15,960 to $23,940 | $33,000 to $49,500 | 94% of costs | $4,000 |
| 150% to 200% | $23,940 to $31,920 | $49,500 to $66,000 | 87% of costs | $4,000 |
| 200% to 250% | $31,920 to $39,900 | $66,000 to $82,500 | 73% of costs | $9,600 |
| Over 250% | Over $39,900 | Over $82,500 | 70% (standard silver) | $12,000 |
Silver vs bronze: how to decide.
A standard silver plan covers about 70% of average costs and a bronze plan about 60%. With cost-sharing reductions, a silver plan at 94% or 87% behaves more like a platinum or gold plan, for a silver premium. And because your tax credit is pegged to a silver plan, silver is often affordable after the credit.
Silver usually wins when
- Your income is under 200% of the poverty level.
- You take regular prescriptions or see specialists.
- Someone in the household has a planned surgery, a pregnancy or a chronic condition.
- A surprise $12,000 bill would be a crisis.
Bronze can make sense when
- Your income is between 200% and 250% and you rarely use care.
- The bronze plan costs close to nothing after your credit and you can save the difference.
- You want an HSA; every bronze plan is HSA-compatible from 2026.
At 73% the benefit is modest. Between 200% and 250% of the poverty level, compare the actual deductibles side by side rather than assuming silver is better.
Mistakes that cost people their savings.
- Picking bronze by premium alone when income is under 200%. You give up a much lower deductible.
- Underestimating income to land in a better band. The cost-sharing reduction itself is not paid back, but the extra premium tax credit is, with no cap starting in 2026.
- Not updating income mid-year. If your income drops into a band, report it on HealthCare.gov; your savings can change for the rest of the year.
- Choosing silver off the Marketplace. Cost-sharing reductions only exist on plans bought through HealthCare.gov.
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Get my free optionsQuestions people ask.
Do I have to pay back cost-sharing reductions?
No. Cost-sharing reductions are not reconciled on your tax return. The premium tax credit is, so an accurate income estimate still matters.
Can I get cost-sharing reductions on a gold plan?
No. For most people they apply only to silver plans. Enrolled members of federally recognized tribes are the exception: their zero and limited cost-sharing works on any metal level except catastrophic.
What is a 94% silver plan?
A silver plan adjusted to cover about 94% of average costs, for incomes from 100% to 150% of the poverty level. Deductibles are often very low, and the 2027 out-of-pocket maximum is $4,000 for one person.
Sources.
- HealthCare.gov, Cost-sharing reductions. healthcare.gov
- 45 CFR 156.420, Plan variations for cost-sharing reductions. ecfr.gov
- CMS, 2027 premium adjustment percentage and maximum out-of-pocket guidance. cms.gov
- IRS Rev. Proc. 2026-26, 2027 applicable percentage table. irs.gov
- H.R. 1 (Public Law 119-21), sections 71304, 71305 and 71307. congress.gov
General information for Texas and Oklahoma residents, not tax or legal advice. Rules and numbers can change; this page is reviewed on the date shown above. Your eligibility and prices are set by HealthCare.gov or the insurer when you apply.
Who wrote this.
RedHealth Advisors LLC is a licensed health insurance agency in Round Rock, Texas (Texas agency license 3449979, NPN 22110493), serving Texas and Oklahoma. Ryan Hutson is a licensed agent (NPN 21321807). Licensing details.