Actuarial Value (AV) Calculator

Estimate actuarial value (AV) and metal tier using CMS continuance tables (standardized population). Quiet truth: most plans feel “fine” until you measure them.

Plan Inputs

Anchored to a standardized population
Plan year start
Used only to display an IRS minimum deductible warning in HDHP/QHDHP mode. AV math is unchanged.
Tip: pick the year your plan starts (e.g., 1/1/2026 or 7/1/2026).
Plan type
Copay plan (copays may apply before deductible)
HDHP / QHDHP (services typically subject to deductible; copays often N/A)
Selecting HDHP will auto-check “subject to deductible” for office visits, ER, and Rx tiers. You can override any line item.
Core cost sharing
If HDHP/QHDHP is selected and this is below the IRS minimum for the plan year, you’ll see a warning (calculation will still run).
Medical services
Service subject to deductible
If checked and copay is $0, we treat this as coinsurance after deductible (HDHP behavior).
Service subject to deductible
If checked and copay is $0, we treat this as coinsurance after deductible.
Service subject to deductible
If checked and copay is $0, we treat this as coinsurance after deductible.
Inpatient is assumed subject to deductible.
Rx tier cost sharing
Service subject to deductible
If checked and copay is $0, we treat as coinsurance after deductible.
Service subject to deductible
If checked and copay is $0, we treat as coinsurance after deductible.
Service subject to deductible
If checked and copay is $0, we treat as coinsurance after deductible.
Service subject to deductible
If checked and copay is $0, we treat as coinsurance after deductible.
Advanced: Rich Coverage Overrides (Imaging/Labs/Outpatient)
Use this only if major buckets are covered first-dollar (deductible waived) and/or at a different plan-pay rate than your base coinsurance. This reduces “missing inputs” distortion without turning the tool into a spreadsheet.
Deductible waived (first-dollar)
Deductible waived (first-dollar)
Deductible waived (first-dollar)
Deductible waived (first-dollar)
Method note (defensible)
This build uses continuance tables to estimate expected spend at different truncation points (“Up To”). We estimate expected deductible paid as E[min(D, eligible spend)], then allocate that expected deductible across deductible-eligible buckets proportionally. Coinsurance is applied to remaining expected spend by bucket, then member cost is capped at MOOP and reduced by HSA/HRA (treated as plan-paid).

Results & Interpretation

Metal tiers: 60 / 70 / 80 / 90
Enter your plan design and click Calculate AV.