Skip to main content

Oregon State Flag An official website of the State of Oregon »

New in 2022: Silver Switcharoo

What is the Silver Switcheroo?

Until 2017, health insurance companies were reimbursed by the federal government for reduced out-of-pocket costs available to consumers eligible for cost-sharing reductions (CSRs) on Silver tier plans. In 2017, those reimbursements stopped, which increased the cost burden for health care services. Starting in 2019, Oregon and many other states applied a “silver load" to all  Silver plans available through the Marketplace. This load increased premiums on Silver plans to cover the extra costs insurance companies have to offer CSR plans. Over the past couple of years, plan premiums for Silver plans have increased at a faster rate than other tiers, which has caused some Silver plans to have a higher premium than Gold plans. For people who purchase coverage directly through an insurance company and for people who earn too much to receive premium tax credits, the cost of Silver plans has become too high to be considered affordable.

This is where the Silver Switcharoo comes in to play. Insurance carriers offer Silver plans with the Silver load as they have been. These plans are required to be sold both through the Marketplace and directly through insurance companies, but are intended mainly for purchase through the Marketplace. Insurance carriers also offer a set of Silver plans that are available only directly through the insurance company. These plans are substantially similar to the on-Marketplace plans, but the premiums do not contain the silver load, and so are lower.

What does this mean to me?

Beginning with open enrollment for plan year 2022, if you have purchased a Silver plan directly through an insurance carrier, you will be informed that less expensive versions of your current coverage are available. If you want, you will be enrolled in these Silver plans.

If you are currently enrolled in a Silver plan directly through an insurance company or through the Marketplace without premium tax credits, you may also want to purchase these plans. To ensure you are aware of the new Silver plans, the Marketplace will provide information about these plans through our Window Shopping tool at later this Fall. You will see these Silver plans only if you are eligible for $0 in premium tax credits. It is important to consider the benefits of enrolling in a health plan through the Marketplace, even if you are currently eligible for $0 in premium tax credits. The tool will explain these benefits, which include:

  • Side-by-side comparison of all available plans
  • Managing enrollment in multiple plans from one account – families can choose to enroll members together or separately; medical and dental coverage can be purchased in one sitting
  • Access to agents and community partners who can help with enrollment in any plan offered through the Marketplace
  • Households not eligible for premium tax credits when they enroll can update their application if they experience a drop in income or other household change and may later become eligible for premium tax credits
    • Some consumers may choose to enroll in a different plan if they become eligible for cost-sharing reductions
    • People who stay on the same plan will continue contributing towards their deductible and out-of-pocket maximum without interruption for the year.
    • Important note: Only consumers who are enrolled through the Marketplace can begin receiving premium tax credits mid-year or claim them on their taxes at the end of the year. Becoming newly eligible for tax credits is considered a qualifying life event, but the Marketplace has not yet implemented the functionality necessary to grant a special enrollment period (SEP) to consumers in this situation.
  • Consumers who move to a different area can easily see which plans are available in their new location and update their enrollment
  • Automatic re-enrollment each year, with updated tax credits and premiums, even if their insurance carrier withdraws from their area

Although the American Rescue Plan has made coverage more affordable by granting more people premium tax credits than ever before, some people may still earn too much to qualify for more than $0 in premium tax credits. This is because the premium tax credit calculation considers the affordability of health plans for you in your area. No one will be required to pay more than 8.5 percent of their income toward their monthly premium, but if your income is high enough, moderately priced plan premiums will all be less than 8.5 percent of your income. If you are one of these people, a less expensive off-Marketplace Silver plan might be a better coverage solution. If you want to forgo the benefits of Marketplace enrollment in favor of less expensive Silver plans, the Marketplace Window Shopping tool will display information for the off-Marketplace Silver plans. These plans will have a link to the insurance carriers' enrollment sites, and you can enroll directly with the insurance carrier.