Estimate the actuarial value of a health insurance plan using average allowed costs, deductible, coinsurance, out-of-pocket maximum, and expected utilization. The result provides a simplified estimate of how healthcare costs may be divided between the plan and the member.
Actuarial Value Calculator
Estimate the actuarial value (AV) of a health plan based on cost-sharing and utilization.
What Is Actuarial Value?
Actuarial Value (AV) is a way of describing the approximate percentage of covered healthcare costs that a health plan is expected to pay for a standard population.
For example, an estimated AV of 70% broadly means the plan would be expected to pay around 70% of covered costs under the assumptions used, while members would account for the remaining portion.
It does not mean your insurance company will pay exactly that percentage of your personal healthcare expenses.
Inputs in This Calculator
Average Annual Allowed Cost
This represents the estimated annual healthcare cost before applying the plan’s cost-sharing structure.
Deductible
The amount a member generally pays toward covered costs before the plan begins paying according to the applicable cost-sharing rules.
Coinsurance
The member’s percentage of covered costs after the deductible.
Out-of-Pocket Maximum
The maximum amount of covered cost-sharing the member is expected to pay under the modeled assumptions.
Expected Utilization
This estimates how much of the allowed healthcare cost is used in the calculation.
How to Use It
Enter the values shown in the calculator:
- Average annual allowed cost
- Deductible
- Coinsurance
- Out-of-pocket maximum
- Expected utilization
The calculator then estimates:
- Plan paid amount
- Member paid amount
- Actuarial Value
Understanding the Result
A higher AV generally means the modeled plan pays a larger share of covered costs, while a lower AV means the member is modeled to pay a larger share.
Important Limitation
This is a simplified estimate. Actual actuarial value calculations can use standardized populations, benefit structures, copayments, service categories, and detailed assumptions that are not represented by a simple calculator.
Do not use this result as a substitute for an insurer’s official plan documents or professional actuarial analysis.
FAQs
Does a 64% AV mean the insurance company will always pay 64% of my bills?
No. AV is a population-level estimate under specified assumptions.
Does AV include my monthly premium?
Actuarial value generally concerns covered healthcare costs and cost sharing, not the premium itself.
Why does utilization matter?
Different levels of healthcare use can change how deductibles, coinsurance, and out-of-pocket limits affect total payments.