Actuarial Value

Acronym: AV

The percentage of total average costs for covered benefits that a plan will cover. For example, if a plan has an AV of 60%, on average, the patient would be responsible for 40% of the costs of all covered benefits. Actuarial value percentages represent how much of a typical population’s medical spending a health insurance plan would cover. For ACA Marketplace plans, which are grouped by “metal tiers,” the actuarial value is 60 percent for bronze plans, 70 percent for silver plans, 80 percent for gold plans, and 90 percent for platinum plans. The higher the actuarial value, the more the plan covers of a typical population’s costs (and thus the typical population would pay less out-of-pocket). A lower actuarial value means the plan covers less of the costs (and the population pays more). The actuarial value calculation focuses mainly on cost-sharing charges. This means that a bronze plan generally would have higher overall enrollee cost sharing than a gold plan would.