Published: June 23, 2026.
Actuarial value is the percentage of total allowed medical costs a plan is designed to cover for a standard population. Bronze plans target about 60 percent, Silver 70 percent, Gold 80 percent, and Platinum 90 percent.
Key Takeaways
- Actuarial value is the percentage of total allowed medical costs a plan is designed to cover for a standard population. Bronze plans target about 60 percent, Silver 70 percent, Gold 80 percent, and Platinum 90 percent.
- AV is a population average, not a promise for any one client. A healthy client with no claims may pay far more than 40 percent out of pocket on Bronze. A high utilizer may hit the out of pocket maximum quickly on any tier.
- CSR raises the effective actuarial value of Silver plans for eligible households without changing the metal label on the card. A CSR enhanced Silver can behave like a Gold plan on cost sharing while keeping Silver premiums.
- Brokers comparing Bronze versus Gold should run client specific scenarios with drugs and doctors, not AV alone. AV explains the tier label, not the client's actual experience.
AV is a population average, not a promise for any one client. A healthy client with no claims may pay far more than 40 percent out of pocket on Bronze. A high utilizer may hit the out of pocket maximum quickly on any tier.
CSR raises the effective actuarial value of Silver plans for eligible households without changing the metal label on the card. A CSR enhanced Silver can behave like a Gold plan on cost sharing while keeping Silver premiums.
Brokers comparing Bronze versus Gold should run client specific scenarios with drugs and doctors, not AV alone. AV explains the tier label, not the client's actual experience.
Related field notes
Related glossary terms
FAQ
Common broker questions about this term.
Is actuarial value the same as the deductible?
No. AV reflects deductibles, copays, coinsurance, and out of pocket maximums together. Two plans with the same AV can have very different deductibles.
Do catastrophic plans have an AV label?
Catastrophic plans meet different standards and are generally available only to eligible under 30 and hardship clients. They are not Bronze plans with a 60 percent AV label.
Why pick Gold if Silver CSR raises AV?
CSR eligible clients often get better cost sharing on Silver than unsubsidized Gold. Unsubsidized clients above 250 percent FPL may still prefer Gold based on utilization.
