Characteristics of Those Eligible for Cost-Sharing Reductions and Premium Tax Credits Under the Affordable Care Act

Quick Strike Series
The emergency room waiting area.

Research finds that by 2016, 13.8 million individuals with very modest incomes will be eligible for “cost-sharing reductions” (CSRs) if they enroll in a marketplace health plan.

The Issue

The Affordable Care Act (ACA) created CSRs to help people with very modest incomes pay for out-of-pocket costs after selecting a marketplace health plan. This assistance is separate from the tax credits provided to help cover the cost of insurance premiums and is designed to help cover otherwise unaffordable deductibles, co-pays and co-insurance.

Key Findings

Of the 13.8 million people eligible for CSRs:

  • 47.9 percent live in the South;

  • 48.9 percent are single adults without children; and

  • 60.0 percent are White, non-Hispanics.

Conclusion

The authors find that if all those eligible enroll in a plan by 2016, they would save, on average, $479 per year on things like co-pays, deductibles and co-insurance. Co-insurance is the percentage of the actual cost of health services—things like prescriptions, imaging tests, hospital stays, etc.—that a person has to pay out-of-pocket for covered services.

About the Grantee

The Urban Institute is a nonprofit, nonpartisan policy research and educational organization that examines the social, economic and governance problems facing the nation. For more information, visit www.urban.org. Follow the Urban Institute on Twitter www.urban.org/twitter or Facebook www.urban.org/facebook. More information specific to the Urban Institute’s Health Policy Center, its staff, and its recent research can be found at www.healthpolicycenter.org.

Cost-sharing Reductions: The ACA Benefit Few People Talk About

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