What Is Actuarial Value? Metal Tiers and What They Really Mean

Actuarial value (AV) is the percentage of total average covered medical costs that a health insurance plan pays for a standard population. A plan with an actuarial value of 70% is expected to pay about 70% of covered costs across a typical group of enrollees, who collectively pay the remaining 30% through deductibles, copays, and coinsurance. It is the single number the ACA uses to sort plans into metal tiers.

The metal tiers

Every ACA individual and small-group plan is labeled by its actuarial value:

• Bronze — about 60% actuarial value. Lowest premium, highest cost-sharing.
• Silver — about 70%. The benchmark tier, and the one tied to premium and cost-sharing subsidies.
• Gold — about 80%. Higher premium, lower cost-sharing.
• Platinum — about 90%. Highest premium, lowest cost-sharing.

Each tier targets its actuarial value within a small allowed range of a few percentage points, so two Silver plans can differ slightly in value and quite a lot in how they structure the cost-sharing to get there.

How it is calculated

Insurers determine a plan's actuarial value with the CMS Actuarial Value Calculator. The calculator takes standardized claims data for a typical population and runs it against the plan's cost-sharing design — deductible, coinsurance, copays, and out-of-pocket maximum — to estimate the share of costs the plan will cover. That output determines the plan's metal tier.

If you want the actuarial value and metal tier of a specific plan from its Summary of Benefits and Coverage, our Actuarial Value Calculator connector computes it inside Claude using an independent implementation of the CMS methodology.

Why it matters for plan selection

Actuarial value is a useful starting point because it makes plans comparable, but it does not account for your specific doctors, prescriptions, or expected care. Lower-income enrollees who qualify for cost-sharing reductions can also get a boosted effective value on Silver plans, raising a 70% plan to as much as 94% for those who qualify. Turning actuarial value into a real recommendation means layering in an individual's expected utilization and provider network, which is what Plan Navigator does for each employee. For how this fits into the bigger picture, see What Is ICHRA?

Frequently asked questions

What are the metal tiers?

The ACA sorts individual and small-group plans into four metal tiers by actuarial value: Bronze covers about 60% of average costs, Silver about 70%, Gold about 80%, and Platinum about 90%. Each tier targets its value within a small allowed range of a few percentage points. Catastrophic plans sit below Bronze and are limited to certain enrollees.

Is a higher actuarial value always better?

No. A higher actuarial value means the plan pays more of your costs, but it also comes with a higher premium. A healthy person who rarely uses care may pay less overall on a Bronze plan, while someone with ongoing medical needs is often better off on a Gold plan despite the higher premium. The right tier depends on expected usage, not on the metal level alone.

How is actuarial value calculated?

Insurers determine a plan’s actuarial value using the CMS Actuarial Value Calculator, which applies standardized claims data for a typical population to the plan’s cost-sharing design — its deductible, coinsurance, copays, and out-of-pocket maximum — and returns the share of costs the plan is expected to pay. The result sets the plan’s metal tier.

Does actuarial value tell me what I will pay?

No. Actuarial value is an average across a standard population, not a personal estimate. Your own costs depend on how much care you use: a light user may pay far less than the average, while a heavy user reaches the out-of-pocket maximum and effectively gets more than the stated value. Actuarial value is a labeling and comparison tool, not a prediction of your spending.