Subsidy: Lowering Your Out-Of-Pocket Costs

  • When you get coverage through the Marketplace, you may be able to get lower costs on deductibles, copayments, and coinsurance. This will depend on your income.
  • The Marketplace cost-sharing reduction lowers the amount you have to pay for out-of-pocket costs like deductibles, coinsurance, and copayments. These are costs you have to pay when you get care.
  • This savings is based on your income and family size.  However, since South Carolina is not expanding Medicaid, not everyone will be able to get a subsidy allowing them to lower their out-of-pocket costs. Click here to learn more about how South Carolina’s decision to not expand Medicaid may affect you.

When you apply for coverage in the Marketplace, you’ll learn if you’re eligible for these savings on out-of-pocket costs.


Out-of-pocket savings apply only to Silver plans

  • Plans in the Marketplace are separated into 4 different categories: Bronze, Silver, Gold, and Platinum. These categories are based on how much of your medical costs you pay and how much the plan pays when you get medical care. They are not based on plan quality. You’ll be able to choose your plan category when you fill out your Marketplace application. Learn more about plan categories (levels of coverage) and what they mean.
  • If you qualify for out-of-pocket savings, you must choose a Silver plan to get the savings. If you qualify for these savings, you’ll get the out-of-pocket savings benefits of a Gold or Platinum plan for a Silver plan price. You can choose any category of plan, but you’ll get the out-of-pocket savings only if you enroll in a Silver plan.