There are two types of savings programs that can lower what you pay each month and out of pocket for your individual or family plan — and over 80% of Highmark Blue Shield ACA members qualify.
Advanced Premium Tax Credits (APTC) - These can lower your monthly premium and are based on your household income and household size.
Cost-Sharing Reduction (CSR) - This program can help lower the out-of-pocket costs that come when you receive care, like deductibles and copays.
Depending on your household size and income, you may be eligible for both an APTC and a CSR.
Deductibles and premiums
A good rule of thumb when it comes to deductibles and premiums is to picture a see-saw: when you lower one, you generally raise the other. This makes it easier to choose an individual or family plan based upon how much you're likely to use it.
High Premium = Low Deductible
Low deductible plans tend to have higher premiums (monthly bills), but may save you money over the long run if you need a lot of health services.
You may want to consider a High Premium / Low Deductible plan if you are:
Pregnant or planning to become pregnant.
Planning major surgery.
Have children in sports who risk injury.
Have a chronic condition.
Take prescription medication.
Low Premium = High Deductible
High deductible plans have higher out-of-pocket costs if you need medical care, but may save you money if you don’t have many health care needs.
You may want to consider a Low Premium / High Deductible plan if you are:
Don’t frequently seek care
Mainly need preventative services.
This five-minute video will help you understand the different metal levels and how to choose one that fits your life.
2Based on 2021 ACA membership that enrolled through the marketplace during 2020 Open Enrollment Period.
All references to “Highmark” in this document are references to the Highmark company that is providing the member’s health benefits or health benefit administration and/or to one or more of its affiliated Blue companies. This website is operated by Highmark, Inc. and is not the Health Insurance Marketplace website. It also does not display all Qualified Health Plans available through the Health Insurance Marketplace website. To see all available Qualified Health Plan options, go to the Health Insurance Marketplace website at HealthCare.gov.
Highmark Blue Cross Blue Shield or Highmark Blue Shield are Medicare Advantage HMO, PPO, and/or Part D plans with a Medicare contract. Enrollment in these plans depends on contract renewal. ®Blue Cross, Blue Shield and the Cross and Shield symbols are registered service marks of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. Benefits and/or benefit administration may be provided by or through the following entities, which are independent licensees of the Blue Cross Blue Shield Association: Western and Northeastern PA: Highmark Inc. d/b/a Highmark Blue Cross Blue Shield, Highmark Choice Company, Highmark Health Insurance Company, Highmark Coverage Advantage Inc., Highmark Benefits Group Inc., First Priority Health, First Priority Life or Highmark Senior Health Company. Central and Southeastern PA: Highmark Inc. d/b/a Highmark Blue Shield, Highmark Benefits Group Inc., Highmark Health Insurance Company, Highmark Choice Company or Highmark Senior Health Company. PA: Your plan may not cover all your health care expenses. Read your plan materials carefully to determine which health care services are covered. For more information, call the number on the back of your member ID card or, if not a member, call 866-459-4418. Delaware: Highmark BCBSD Inc. d/b/a Highmark Blue Cross Blue Shield. West Virginia: Highmark West Virginia Inc. d/b/a Highmark Blue Cross Blue Shield, Highmark Health Insurance Company or Highmark Senior Solutions Company. Visit our website to view the Access Plan required by the Health Benefit Plan Network Access and Adequacy Act. You may also request a copy by contacting us at the number on the back of your ID card. Western NY: Highmark Western and Northeastern New York Inc. d/b/a Highmark Blue Cross Blue Shield. Northeastern NY: Highmark Western and Northeastern New York Inc. d/b/a Highmark Blue Shield.
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