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What is actuarial value?


Actuarial value compares how much the insurance company will pay versus how much you will pay for health care costs. The percentage the plan pays depends on the cost-sharing details – how much out-of-pocket the consumer pays for deductibles, coinsurance, and copayments and the out-of-pocket limits. The percentage is an estimate of what the plan will pay for all policyholders. Your individual benefits may be more or less.

Actuarial value only reflects differences in cost-sharing. It doesn't give any other information about a plan that may be important to a particular person or affect their costs. It doesn't tell you how broad or narrow a plan's provider network is, the quality of the provider network, about the plan's customer service and support, how broad or narrow the drug formulary is, or the premium levels. All of this information is important for consumers to consider when they choose a plan.

See healthcare.gov for additional information for consumers about actuarial value.

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