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<p>Bot: Creating new article from JSON</p> <p><b>New page</b></p><div>🖩 &#039;&#039;&#039;Actuarial value calculator&#039;&#039;&#039; is a standardized computational tool used in the [[Definition:Health insurance | health insurance]] market to determine the [[Definition:Actuarial value (AV) | actuarial value]] of a plan — the percentage of total allowed [[Definition:Claim | medical costs]] that the plan is expected to cover for a standard population. In the United States, the [[Definition:Centers for Medicare and Medicaid Services (CMS) | Centers for Medicare and Medicaid Services]] publishes an official actuarial value calculator that [[Definition:Insurance carrier | insurers]] and [[Definition:Health insurance exchange | marketplace]] plan issuers must use when designing and certifying their products under the [[Definition:Affordable Care Act (ACA) | Affordable Care Act]].<br /> <br /> ⚙️ The calculator operates on a reference claims database representing a standard population&#039;s healthcare utilization. An issuer inputs the plan&#039;s [[Definition:Cost-sharing | cost-sharing]] parameters — [[Definition:Deductible | deductibles]], [[Definition:Copayment | copayments]], [[Definition:Coinsurance | coinsurance]] rates, and [[Definition:Out-of-pocket maximum | out-of-pocket maximums]] — and the tool simulates how those provisions interact with the reference population&#039;s expected claims to produce an actuarial value percentage. Plans are then classified into [[Definition:Metal tier | metal tiers]]: bronze (roughly 60%), silver (70%), gold (80%), and platinum (90%). The calculator is updated annually to reflect new claims data and regulatory adjustments, and [[Definition:Actuary | actuaries]] may use approved alternative methodologies for plan designs that fall outside the tool&#039;s standard inputs, provided the results are certified as consistent with federal requirements.<br /> <br /> 💡 By mandating a single, transparent calculation framework, the actuarial value calculator creates a level playing field in the individual and small-group [[Definition:Health insurance | health insurance]] markets. Consumers can compare plans within a metal tier knowing that each covers approximately the same share of expected costs, even if the specific [[Definition:Benefit design | benefit designs]] differ. For insurers and their [[Definition:Actuary | actuarial]] teams, the tool also imposes a discipline: plan designs must be engineered to land within the prescribed [[Definition:Actuarial value (AV) | AV]] bands, which means [[Definition:Product development | product development]] becomes a careful optimization exercise balancing [[Definition:Premium | premium]] competitiveness, [[Definition:Cost-sharing | cost-sharing]] structures, and regulatory compliance.<br /> <br /> &#039;&#039;&#039;Related concepts:&#039;&#039;&#039;<br /> {{Div col|colwidth=20em}}<br /> * [[Definition:Actuarial value (AV)]]<br /> * [[Definition:Affordable Care Act (ACA)]]<br /> * [[Definition:Metal tier]]<br /> * [[Definition:Cost-sharing]]<br /> * [[Definition:Health insurance exchange]]<br /> * [[Definition:Benefit design]]<br /> {{Div col end}}</div>

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