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Actuarial Value

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These levels are based on an actuarial value (AV) of benefits provided without cost sharing. AV is a measure of EHB coverage estimated to be paid by the QHP issuer for a standard population, expressed in percentages. The higher the AV, the more the enrollee will pay in monthly premiums and the less he or she will pay in out-of-pocket costs. It is important to emphasize that AV is an average measure of generosity – the percentage of medical costs the plan will cover after premium payments.

Catastrophic - A catastrophic plan offers a level of coverage that does not meet a specific AV but must comply with the maximum out-of-pocket limit

Bronze - 60% AV (the QHP issuer pays, on average, 60% of the cost of EHB coverage)

Silver - 70% AV (the QHP issuer pays, on average, 70% of the cost of EHB coverage)

Gold - 80% AV (the QHP issuer pays, on average, 80% of the cost of EHB coverage)

Platinum - 90% AV (the QHP issuer pays, on average, 90% of the cost of EHB coverage)

Next Topic: Out of Pocket Limits



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