Are cost-sharing reductions (CSRs) available in 2026 and who qualifies?
This fact-check may be outdated. Consider refreshing it to get the most current information.
Executive summary
Cost‑sharing reductions (CSRs) remain available for 2026 to people who buy a Silver Marketplace plan and meet income and eligibility rules: broadly, individuals and families with household incomes up to 250% of the federal poverty level qualify for the federal CSR tiers, with the deepest reductions for those at 100–200% FPL and more modest reductions for 201–250% FPL (CMS guidance and KFF) [1] [2]. State programs can expand or adjust offerings (New York and some state marketplaces note broader or different limits) and American Indian/Alaska Native enrollees have special rules [3] [4].
1. What CSRs do and the simple rule to get them — “Buy Silver”
Cost‑sharing reductions lower deductibles, copays, coinsurance and the plan out‑of‑pocket maximum, and they are available only if an eligible enrollee selects a Silver Marketplace plan — the marketplace automatically enrolls eligible applicants into the Silver variant with reduced cost sharing (HealthCare.gov glossary and guidance) [4] [5].
2. Who qualifies on income: the federal baseline for 2026
Federal guidance and policy summaries state that, for 2026, CSRs apply to people with household incomes at or below 250% of the federal poverty level — with the largest reductions for those between 100% and 200% FPL and smaller reductions for 201–250% FPL (CMS PAPI guidance; HealthReformBeyondtheBasics) [1] [6]. KFF and HealthInsurance.org translate those percentages into 2026 dollar examples (for a single person, roughly $15,650–$39,125 depending on the bracket cited) when explaining how the tiers map to cash amounts [2] [7].
3. How deep the reductions are — tiers and out‑of‑pocket caps
CMS documentation specifies the formula used to reduce the maximum annual limitation on cost sharing: a 2/3 reduction of the cap for enrollees with incomes 100–200% FPL, a 1/5 reduction for 200–250% FPL, and no reduction above 250% FPL; the reduced maximums are applied to Silver plan variants for 2026 [1]. KFF and consumer‑facing outlets give concrete examples of resulting out‑of‑pocket maximums and note that the 100–200% group receives the steepest protections [2] [7].
4. State variations and expanded programs — don’t assume federal limits are the only story
Some state marketplaces and programs have expanded or different approaches. New York’s materials say federal changes could alter CSRs in 2026 but also describe “Silver Enhanced” or “Silver Supreme” offerings and note eligibility expansions in state programs up to 350% FPL for some enhanced plans, and Vermont’s site shows its own rules [3] [8] [9]. These state initiatives demonstrate that while the federal baseline is up to 250% FPL, state policy decisions can create broader or different cost‑sharing relief within their marketplaces [3] [8].
5. The politics and funding context — why readers should care
Historically, the availability and funding of CSRs have been politically contested. Congressional and legal debates have affected federal payments and insurer behavior; the statutory obligation for issuers to provide CSRs exists alongside disputes over federal reimbursement, which in past years led insurers and states to take offsetting actions (Congress Research Service summary) [10]. This background explains why statelevel fixes or plan design choices can matter for consumers even when federal rules appear stable [10].
6. Practical steps for people checking eligibility in 2026
To confirm whether you qualify and to see exact plan designs and out‑of‑pocket numbers, apply through your state or federal Marketplace and select “with financial help” when estimating — marketplaces will show which Silver plans include CSR variants and the applicable savings; insurers and state marketplaces also publish plan‑specific CSR details (MNsure guidance; Anthem consumer pages) [11] [12]. HealthInsurance.org and HealthCare.gov also explain that more than 12 million enrollees historically used CSR‑enhanced plans, so checking marketplace tools is essential [7] [5].
Limitations and sourcing note: This analysis uses federal CMS parameters, marketplace guidance and state marketplace documents supplied here; available sources do not mention specific 2026 dollar tables for every family size beyond the single‑person examples provided in KFF and HealthInsurance.org [2] [7]. Where state materials differ, the state source is cited.