Actuarial value
Updated for plan year 2026
In plain terms
Actuarial value is the average percentage of covered medical costs a plan pays across a standard population, the figure behind the metal tiers. A bronze plan has an actuarial value of about 60 percent, silver about 70 percent, gold about 80 percent, and platinum about 90 percent, with a small allowed variation. It describes the plan's overall generosity, not what any one person will pay: your actual share depends on how much care you use and how the deductible, copays, and coinsurance are structured.
A plain example
A gold plan with an 80 percent actuarial value is built to cover, on average, 80 cents of every dollar of covered care across all its members. That doesn't mean your own bills are 80 percent covered. A low-use year could leave you paying a larger share through the deductible, while a high-use year could push the plan's share well past 80 percent for you.
Why it matters
Actuarial value is the engine under the metal-tier labels, so it explains the premium-versus-out-of-pocket trade you're really choosing. A higher value means the plan absorbs more on average, useful if you expect steady care, at the cost of a higher premium.
A common point of confusion
Actuarial value is an average across many people, not a promise about your bills. An 80 percent plan won't pay 80 percent of your specific costs, since your share swings with how much care you use and how the plan's deductible and copays are arranged.