Covered California Silver CSR Plans

by | Aug 23, 2023

Covered California Silver CSR Plans

What are Covered California Silver CSR Plans?

Navigating the world of health insurance can be complex, but with the new enhancements to Covered California’s Silver Cost Sharing Reduction (CSR) plans, the journey just became a little more seamless and pocket-friendly. This 2024 update is especially exciting for Californians who have been eager for more support and transparency in their healthcare.

Delving into the “Enhanced” Silver Plans

When diving into the specifics, Covered California offers three distinct “Enhanced” Silver plans: Silver 73, 87, and 94. These aren’t just ordinary plans, they are designed to provide superior out-of-pocket savings to enrollees. If your income makes you eligible for one of these Enhanced Silver plans, you can expect considerably lower copays, coinsurance, and deductibles. In essence, they provide an optimal combination of premium cost and out-of-pocket expenses for qualified individuals.

 

2024 (CSR) Plans

Silver 73 Plan

With this plan you will be required to pay approximately 27% of your medical expenses.

  • Annual Wellness Exam $0
  • Primary and Urgent Care $35.00 per visit
  • Specialist visit $85.00
  • Emergency Room Facility $350.00
  • Laboratory Tests $50.00
  • X-rays & Diagnostics $95.00
  • Imaging $325.00
  • Drugs Tier 1 (Generic Drugs) $15
  • Drugs Tier 2 (Preferred Drugs) $55
  • Drugs Tier 3 (Non-Preferred Drugs) $85
  • Drugs Tier 4 (Specialty Drugs) 20% up to $250 per script***
  • Medical Deductible N/A
  • Pharmacy Deductible N/A
  • Annual Out-of-Pocket Maximun $6,100 (Individual)
  • $12,200 (Family)

Silver 87 Plan

With this plan you will be required to pay approximately 13% of your medical expenses.

  • Annual Wellness Exam $0
  • Primary and Urgent Care $15.00 per visit
  • Specialist visit $25.00
  • Emergency Room Facility $150.00
  • Laboratory Tests $20.00
  • X-rays & Diagnostics $40.00
  • Imaging $100.00 
  • Drugs Tier 1 (Generic Drugs) $5
  • Drugs Tier 2 (Preferred Drugs) $25
  • Drugs Tier 3 (Non-Preferred Drugs) $45
  • Drugs Tier 4 (Specialty Drugs) 15% up to $150 per script***
  • Medical Deductible N/A
  • Pharmacy Deductible N/A
  • Annual Out-of-Pocket Maximun $3,000 (Individual)
  • $6,000 (Family)

Silver 94 Plan

With this plan you will be required to pay approximately 6% of your medical expenses.

  • Annual Wellness Exam $0
  • Primary and Urgent Care $5.00 per visit
  • Specialist visit $8.00
  • Emergency Room Facility $50
  • Laboratory Tests $8
  • X-rays & Diagnostics $8
  • Imaging $50 
  • Drugs Tier 1 (Generic Drugs) $3
  • Drugs Tier 2 (Preferred Drugs) $10
  • Drugs Tier 3 (Non-Preferred Drugs) $15
  • Drugs Tier 4 (Specialty Drugs) 10% up to $150 per script***
  • Medical Deductible N/A   
  • Pharmacy Deductible N/A 
  • Annual Out-of-Pocket Maximun $1,150 (Individual)
  • $2,300 (Family)

Say Goodbye to Deductibles and Hello to New Benefits

2024 is set to be a transformative year for health insurance in California. Here are some benefits you should be aware of:

  • No More Deductibles: Deductibles can often be a barrier to accessing necessary medical care. Recognizing this, all three Silver CSR plans have eliminated deductibles entirely for 2024. This streamlines the plan selection process and ensures that more Californians can access care when they need it without worrying about meeting a deductible first.
  • Reduced Drug Costs: Prescription medications can be expensive. Thankfully, enrollees will now see lowered costs for generic drugs, making necessary medications more accessible.
  • Lowered Copays: Whether you need a routine check-up, have to see a specialist, or face an emergency, you’ll be pleased to note that copays for primary care, emergency care, and specialist visits have been reduced.
  • Decreased Out-of-Pocket Maximum: A lowered out-of-pocket maximum means that Californians will spend less overall, even if they require extensive medical care.

More Financial Help on the Horizon

The promise of health insurance that is not only robust but also affordable is finally here. And much of this welcome change can be attributed to the Affordable Care Act subsidies coupled with the additional financial aid provided in California. Here’s what’s new:

  1. Steady Monthly Coverage Costs: Most enrollees will continue to experience the same monthly coverage costs they’ve come to expect, with no surprise hikes in 2024.
  2. Decreased Monthly Expenses: What’s even more thrilling? Some enrollees will find that their monthly expenses are decreasing!
  3. Enhanced Subsidies: The Inflation Reduction Act has introduced enhanced subsidies that guarantee record-low monthly expenses for many Californians.
  4. Zero Premiums for Many: Nearly one in five enrollees will enjoy absolutely no premiums. That’s right, 20% of enrollees will be fully covered without any premium costs.
  5. State-Legislated Financial Support: Californians who earn up to 250 percent of the federal poverty level are in for a treat in 2024. They’ll benefit from the state’s new financial aid, which particularly amplifies the perks of the Silver CSR plans.

In conclusion, the enhancements to Covered California’s Silver CSR plans in 2024 reflect a significant step towards more equitable, accessible, and affordable healthcare for all Californians. It’s a testament to the state’s commitment to the well-being of its residents. Whether you’re enrolling for the first time or revisiting your current plan, these changes promise a brighter, healthier future. So, here’s to a year of wellness and savings!

Income Qualifications for CSR Plans
Income as % of Federal Poverty Level
Qualifying CSR Plan
Greater than 138%-150%
Silver 94
Greater than 150%-200%
Silver 87
Greater than 200%-250%
Silver 73
Federal Poverty Level Chart (2024)
Household Size
138% FPL
150% FPL
200% FPL
250% FPL
1
$20,121
$21,870
$29,160
$36,450
2
$27,214
$29,580
$39,440
$49,300
3
$34,307
$37,290
$49,720
$62,150
4
$41,400
$45,000
$60,000
$75,000
5
$48,494
$52,710
$70,280
$87,850
6
$55,587
$60,420
$80,560
$100,700
7
$62,680
$68,130
$90,840
$113,550
8
$69,773
$75,840
$101,120
$126,400

Understanding the Chart and MAGI

The chart provided above offers a snapshot into the eligibility criteria for CSR plans based on your income relative to the Federal Poverty Level. However, a critical detail to keep in mind is that this determination leans on your (MAGI) Modified Adjusted Gross Income.

MAGI, as defined by the IRS, helps determine eligibility for specific tax benefits. In the realm of health insurance, it plays a pivotal role in assessing qualifications for subsidies. If the world of MAGI feels daunting or if you’re unsure about where you stand, we’re here to bridge the knowledge gap.

Take the Next Step

Uncertain about your MAGI or how it connects with CSR plans? We’ve got your back. Reach out and let our experts guide you.

Contact our Enrollment Center at (888) 280-0763 to see if you qualify for a CSR plan.

This article was written by Mark Svetlik, with the assistance of automation technology. The content has undergone thorough editing and fact-checking to ensure complete accuracy.

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