Health Plan Actuarial Value Calculator
This calculator estimates the actuarial value (AV) of a health insurance plan by modelling the plan's cost-sharing features (deductible, coinsurance, out-of-pocket maximum) applied to an assumed distribution of annual medical costs. Actuarial value is the percentage of covered costs paid by the plan for a standard population. Under the Affordable Care Act (ACA), all individual and small-group plans must meet AV targets for Bronze (60%), Silver (70%), Gold (80%), and Platinum (90%) tiers. Enter your plan's cost-sharing parameters and total expected annual spending to estimate the plan's share of covered costs.
Actuarial value formula
Member cost = min(Deductible, Spend) + min(Coinsurance% x max(Spend - Deductible, 0), OOPM - Deductible)
Member cost = min(Member cost, OOPM)
AV = (Spend - Member cost) / Spend x 100
For individual spending above the OOPM, the plan covers all costs. For spending below the deductible, the member bears the full cost. Between deductible and OOPM, costs are split by the coinsurance rate.
ACA metal tiers and actuarial value
- Bronze (60% AV): lowest premiums, highest out-of-pocket exposure. Best for healthy people with few expected claims.
- Silver (70% AV): eligible for cost-sharing reduction subsidies. The reference tier for marketplace subsidies.
- Gold (80% AV): higher premium, lower cost-sharing. Better value if you expect frequent medical use.
- Platinum (90% AV): highest premium, lowest cost-sharing. Best for people with chronic conditions or high expected spending.
- CMS certifies plans using a standardised actuarial value calculator; plans must be within 2 percentage points of the target AV.
Health plan actuarial value: frequently asked questions
What is actuarial value in health insurance?
Actuarial value (AV) is the percentage of total covered medical expenses that a health plan pays on average for a standard population of enrollees. A plan with 70 percent AV (Silver tier) pays 70 cents of every dollar of covered costs; the enrollee pays the remaining 30 cents through deductibles, copays, and coinsurance.
What are the ACA metal tiers and their AV levels?
The ACA mandates four metal tiers: Bronze (60% AV, +/-2%), Silver (70% AV, +/-2%), Gold (80% AV, +/-2%), and Platinum (90% AV, +/-2%). Catastrophic plans have no AV requirement. AV is calculated using a CMS-certified actuarial value calculator applied to a standardised population.
How is AV different from the amount I personally pay?
AV reflects average costs for a standardised population, not your individual situation. If you are healthy and rarely use healthcare, your personal out-of-pocket share will be much lower than implied by (1 - AV). If you have high health needs, your share could exceed the average. AV is a tool to compare plan generosity, not to predict your personal costs.
What factors determine a plan's actuarial value?
AV is driven by the deductible, copay amounts, coinsurance percentage, and out-of-pocket maximum (OOPM). Plans with lower deductibles, lower coinsurance rates, and lower OOPMs have higher AV. The CMS AV calculator applies these cost-sharing features to a standard population cost distribution to compute AV.
Do cost-sharing reductions (CSRs) affect AV?
Yes. Silver plan enrollees with incomes between 100 and 250 percent of the federal poverty level who receive cost-sharing reduction subsidies are placed on enhanced Silver plans with effective AV of 73, 87, or 94 percent, depending on income level. The plan structure looks the same but cost-sharing is lower for these enrollees.
Official sources
- CMS: CMS Actuarial Value Calculator.
- CMS CCIIO: ACA AV Methodology.
Reviewed by the CalculatorHub team, edited by James Graham, 15 June 2026. See our methodology.