Cost-Sharing Reductions: When a Silver Plan Beats a Gold Plan in 2027
Who qualifies for cost-sharing reductions in 2027, how they upgrade a Silver plan, and worked examples comparing Silver with Gold and Bronze.
A Silver plan can beat a Gold plan when your income qualifies you for cost-sharing reductions, and the case is strongest if your household income is at or below 200% of the federal poverty level. In that range a Silver plan carries a 94% or 87% actuarial value and, for 2027, an out-of-pocket maximum of no more than $4,000 for one person, for a Silver premium.
Between 200% and 250% of the poverty level the boost is smaller, and a Gold plan can come out ahead depending on prices where you live. Open enrollment for 2027 coverage on HealthCare.gov runs from November 1, 2026 to January 15, 2027.
Key takeaways
- Cost-sharing reductions lower your deductible, copays, coinsurance and out-of-pocket maximum. You get them only in a Silver plan.
- For 2027 coverage they are available with household income from 100% to 250% of the poverty level: $15,960 to $39,900 for one person in the 48 contiguous states and DC.
- The 2027 out-of-pocket maximum drops from the standard $12,000 to $4,000 (up to 200% of poverty) or $9,600 (200% to 250%) for one person.
- A Silver plan with reductions costs the same premium as the standard version of that Silver plan.
- Gold can win in the 200% to 250% band, especially where insurers have raised Silver premiums to cover the unfunded cost of these reductions.
What cost-sharing reductions are
Cost sharing is what you pay when you use care: the deductible (what you pay before the plan starts paying for most services), copays (fixed fees per visit or prescription) and coinsurance (a percentage of the bill). Cost-sharing reductions, which HealthCare.gov calls "extra savings", cut all three and lower your yearly out-of-pocket maximum.
They work by moving you into a version of a Silver plan, called a plan variant, with a higher actuarial value: the share of average covered costs the plan pays. A standard Silver plan has a 70% actuarial value. With reductions, the same plan pays 73%, 87% or 94% depending on your income. The 87% level is above a Gold plan (80%), and the 94% level is above a Platinum plan (90%).
Three conditions apply. You must qualify for advance payments of the premium tax credit through the Marketplace, your expected household income for the year must be no more than 250% of the poverty level, and you must enroll in a Silver plan through the Marketplace. If you pick Bronze or Gold you can still use your premium tax credit, but you lose the reductions. Your Marketplace eligibility notice shows whether you qualify (the wording is quoted in the questions at the end of this guide).
Who qualifies for 2027 coverage
Marketplace savings for 2027 are based on the 2026 federal poverty guidelines: $15,960 for one person and $33,000 for a family of four in the 48 contiguous states and DC. The figures are higher in Alaska and Hawaii. The table shows the three bands for plan year 2027.
| Household income (% of poverty level) | One person | Family of four | Silver actuarial value | 2027 out-of-pocket maximum |
|---|---|---|---|---|
| 100% to 150% | $15,960 to $23,940 | $33,000 to $49,500 | 94% | $4,000 self-only / $8,000 family |
| Above 150% to 200% | up to $31,920 | up to $66,000 | 87% | $4,000 self-only / $8,000 family |
| Above 200% to 250% | up to $39,900 | up to $82,500 | 73% | $9,600 self-only / $19,200 family |
For comparison, the standard 2027 limit for every other Marketplace plan is $12,000 for one person and $24,000 for a family. Insurers can set lower maximums than these, so the figures in the table are ceilings.
A few groups follow different rules:
- Lower incomes. In states that have expanded Medicaid, income below 138% of the poverty level may mean Medicaid eligibility instead.
- American Indians and Alaska Natives. Members of federally recognized tribes and Alaska Native Claims Settlement Act shareholders with income under 300% of the poverty level can get zero-cost-sharing plan variants, and the Silver-only rule applies to other enrollees, not to them.
- Some lawfully present immigrants. Starting with plan year 2027, a 2025 federal law limits premium tax credits, and with them income-based cost-sharing reductions, to U.S. citizens, U.S. nationals and "eligible noncitizens": lawful permanent residents, Cuban and Haitian entrants, and Compact of Free Association migrants. Other lawfully present immigrants can still enroll but pay the full price.
Worked example: Silver with reductions against Gold and Bronze
The premium tax credit equals the premium of the second-lowest-cost Silver plan in your area (the benchmark) minus an expected contribution set as a percentage of your income, and it cannot exceed the premium of the plan you pick. For 2027, someone at exactly 200% of the poverty level is expected to pay 6.78% of income toward the benchmark plan.
Example: A single adult expects 2027 household income of $31,920, exactly 200% of the poverty level, so they qualify for the 87% Silver variant. Their expected contribution is 6.78% of $31,920, or about $2,164 a year. Suppose the benchmark Silver plan's full price is $7,200 a year: the tax credit is about $5,036 ($7,200 minus $2,164). The full prices and plan designs below are illustrative. The Silver out-of-pocket maximum is set at the 2027 legal ceiling for this income band, $4,000.
| Plan | Yearly premium after credit | Deductible | Coinsurance | Out-of-pocket maximum |
|---|---|---|---|---|
| Silver with 87% reductions (benchmark, full price $7,200) | $2,164 | $800 | 15% | $4,000 |
| Gold (full price $7,800) | $2,764 | $1,500 | 20% | $7,000 |
| Bronze (full price $5,400) | $364 | $7,500 | 40% | $10,000 |
Using a simple model (you pay everything up to the deductible, then the coinsurance share, until you reach the maximum; preventive care is free on all three), here is the total yearly cost, premium plus out-of-pocket:
| Plan | Low use ($1,000 of care) | Medium use ($8,000) | High use ($40,000) |
|---|---|---|---|
| Silver with reductions | $2,994 | $4,044 | $6,164 |
| Gold | $3,764 | $5,564 | $9,764 |
| Bronze | $1,364 | $8,064 | $10,364 |
Silver with reductions beats Gold at every level of use here: it costs less in premium and less in cost sharing. Bronze wins only in a quiet year. In this example, once covered bills pass about $2,900, the Silver plan becomes cheaper than Bronze, and in a bad year it saves more than $4,000 compared with Bronze.
When Gold can come out ahead
The picture changes in the 200% to 250% band. The 73% variant is only 3 points above a standard Silver plan, and its out-of-pocket maximum for 2027 can be as high as $9,600 for one person. If a Gold plan in your area has a lower maximum, it caps your worst year at a lower figure.
Prices push in the same direction. Insurers still have to provide the reductions, but the federal government stopped reimbursing them in October 2017. Insurers responded by raising premiums, and in most states the extra cost was added to Silver premiums alone, since Silver is the only tier that carries the reductions. This is called "silver loading". The tax credit is calculated from the benchmark Silver premium, so a higher Silver premium means a bigger credit for every subsidized enrollee, including those who pick another tier. After the credit, a Bronze plan, and in some areas a Gold plan, can then cost very little. CMS's 2027 payment rule requires insurers that raise rates to cover unreimbursed reductions to report details of that loading in their rate filings, starting with the plan year 2027 filings.
Example: A single adult with expected 2027 income of about 240% of the poverty level qualifies for the 73% Silver variant. In their area, after the tax credit, the Silver plan costs $3,200 a year (deductible $3,500, 25% coinsurance, $9,600 maximum, the 2027 ceiling for this band) and the cheapest Gold plan costs $3,400 (deductible $1,500, 20% coinsurance, $7,000 maximum). All plan figures are illustrative. With $1,000 of care, Silver totals $4,200 and Gold $4,400. With $8,000 of care, Silver totals $7,825 and Gold $6,200. In a $40,000 year, Silver totals $12,800 and Gold $10,400. Gold becomes the cheaper plan once covered bills pass about $1,750.
The pattern that falls out: in the 73% band, if a Gold plan's after-credit premium is close to Silver's and its deductible and out-of-pocket maximum are lower, Gold is likely to cost less in any year with more than light use. At 87% and 94%, the Silver plan pays a larger share of costs than a Gold plan, so Gold generally needs a lower after-credit premium to win in a light year. For a bad year, compare each plan's after-credit premium plus its out-of-pocket maximum, remembering that the Silver plan's maximum is no more than $4,000. Our guide to choosing a metal tier shows the same method without reductions.
Getting your income estimate right
Your reduction level comes from the income you estimate on your application, so a few hundred dollars can move you between bands. An accurate estimate matters. Advance payments of the premium tax credit are reconciled on your tax return, and for tax years after 2025 there is no cap on repaying an excess: if your actual income is higher than you estimated, you repay the full difference. Our guide to how premium tax credits work explains reconciliation on Form 8962.
Report income changes during the year. Losing cost-sharing reductions while on a Silver plan opens a special enrollment period, during which a switch to a Bronze, Silver or Gold plan is allowed. Before choosing, check that your doctors and drugs are covered, then compare total yearly cost at low, expected and worst-case use.
Frequently asked questions
Does a Silver plan with cost-sharing reductions cost more in premiums?
No. The reduced cost sharing comes with the same premium as the standard version of that Silver plan. The premium you pay depends on your tax credit, not on the reductions.
Are cost-sharing reductions available with a Gold or Bronze plan?
No, unless you are a member of a federally recognized tribe or an Alaska Native Claims Settlement Act shareholder. For everyone else, the reductions apply only to Silver plans. You can still use your premium tax credit on a Gold or Bronze plan.
How can you tell whether you qualify, and at what level?
HealthCare.gov says to check the eligibility determination notice you get after applying. If it says "Can choose a health plan with lower copayments, coinsurance, and deductibles" followed by (04), (05) or (06), the income-based savings apply, but only in a Silver plan. The exact amount appears when you compare Silver plans in the Marketplace.
What happens if income goes up during 2027?
Update your application. Your tax credit and reduction level may change, and if you lose the reductions you can switch to a Bronze, Silver or Gold plan through a special enrollment period. Any excess advance credit is repaid in full when you file taxes.
Do catastrophic plans come with cost-sharing reductions?
No. Catastrophic plans are not eligible for cost-sharing reductions or the premium tax credit at any income.
Sources
- Cost-sharing reductions (HealthCare.gov)
- Federal poverty level (FPL) (HealthCare.gov)
- Premium Adjustment Percentage, Maximum Annual Limitation on Cost Sharing, Reduced Maximum Annual Limitation on Cost Sharing for 2027 (Centers for Medicare & Medicaid Services)
- 45 CFR 155.305: Eligibility standards (Legal Information Institute, Cornell Law School)
- Revenue Procedure 2026-26: 2027 applicable percentage table (Internal Revenue Service)
- Questions and answers on the premium tax credit (Internal Revenue Service)
- Explaining Cost-Sharing Reductions and Silver Loading in ACA Marketplaces (KFF)
- HHS Notice of Benefit and Payment Parameters for 2027 Final Rule (Centers for Medicare & Medicaid Services)