AV Calculator Methodology

Actuarial value (AV) is the share of total allowed medical costs a plan pays for a standard population — not for any one person. An AV near 70% means the plan pays ~70% of covered costs on average, and the enrollee pays the rest through the deductible, coinsurance, and copays (up to the out-of-pocket maximum).

The calculator estimates AV by applying your plan's cost-sharing to a fixed continuance table — a claims distribution for each metal tier that encodes how spending is spread across the standard population and its service categories. It integrates what the plan pays below the deductible, in the coinsurance range up to the MOOP, and above the MOOP (where the plan pays 100%).

The resulting AV maps to a metal tier within a de minimis range: Bronze ~60%, Silver ~70%, Gold ~80%, Platinum ~90%, plus expanded-bronze and cost-sharing-reduction (CSR) variants. The official methodology below is the authoritative description.