What Is Actuarial Value?
Actuarial value (AV) is the percentage of total healthcare costs that a health plan pays for a standard population. It represents the average cost-sharing split between the insurer and enrollees.
Metal Tier Actuarial Values
- Bronze: ~60% AV — plan pays 60%, you pay 40% on average
- Silver: ~70% AV — plan pays 70%, you pay 30% on average
- Gold: ~80% AV — plan pays 80%, you pay 20% on average
- Platinum: ~90% AV — plan pays 90%, you pay 10% on average
⚠️ Actuarial value represents averages across a population — your individual experience may vary significantly based on how much healthcare you use.
A 60% AV plan doesn't mean you pay 40% of every bill. It means that across all enrollees, the total out-of-pocket costs average 40% of total medical costs. Some people pay much more, others pay less.
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