Actuarial value, or AV, is the average amount of a health plan’s covered medical expenses paid by the insurance provider. The remainder of the expenses are the financial responsibility of the health plan enrollee. The enrollee expenses are typically in the form of deductibles, copayments, coinsurance fees, and maximum out-of-pocket (MOOP) limits.
The actuarial value of a health insurance plan is expressed as a percentage. For example, if a plan has a 70 percent AV, the insurer pays 70 percent of the typical enrollee costs and the enrollee pays the other 30 percent.
An Affordable Care Act health plan actuarial value is permitted to vary slightly (below or above) within a prescribed range. This permitted variation is called the de minimis range.
Do ACA health plans all have the same actuarial value?
No. There are four standard tiers of ACA health plans, each with a distinct actuarial value. A bronze plan has an actuarial value of 60 percent, a silver plan 70 percent, a gold plan 80 percent, and a platinum plan has an actuarial value of 90 percent.
Additional Paragon Resources