Eligible Vermonters can save money with cost-sharing reduction plans—also called Enhanced Silver plans. Enhanced Silver plans lower the amount of money you pay out-of-pocket for medical care, including:
- Lower deductibles (you pay less money out of pocket before your plan starts to pay for covered services)
- Lower co-pays (you pay less money when you go to the doctor or fill a prescription)
- Lower max-out-of-pocket limits (you pay less money out of pocket over the plan year)
Enhanced Silver plans cover more of your out-of-pocket costs than regular silver plans, so you pay less. The percent of expenses your plan covers, on average, is called the actuarial value (AV) of your plan. Enhanced silver plans have a higher AV, which means they pay more of your out-of-pocket costs, on average. This means the Enhanced Silver plans will have lower deductibles, copayments, and maximum out of pocket limits than regular silver plans for the same monthly premium as a regular silver plan.
Depending on your eligibility, you could qualify for one of four Enhanced Silver plan levels:
- Enhanced Silver 94 plans—have an AV of 94%. You pay 6% of your medical costs, on average
- Enhanced Silver 87 plans— have an AV of 87%. You pay 13% of your medical costs, on average
- Enhanced Silver 77 plans— have an AV of 77%. You pay 23% of your medical costs, on average
- Enhanced Silver 73 plans— have an AV of 73%. You pay 27% of your medical costs, on average
- Regular silver plans (not enhanced) have an AV of 70%. You pay 30% of your medical costs, on average
Each level of Enhanced Silver has five different plans you can choose from. Once you find out which level of Enhanced Silver you’re eligible for, you can pick any one of the five plans in that level. Eligibility for Enhanced Silver plans is based on your household size and income.
Not sure if you’re eligible to get an Enhanced Silver plan? Get an estimate using our Plan Comparison Tool—or call our Customer Service Center at 1-855-899-9600 to apply and learn more.