Actuarial equivalence

Actuarial value is a measure of how much financial protection you get from a health insurance plan. Two health plans that pay the same percentage of medical expenses are said to have benefits that are actuarially equivalent. For example, two health plans that both pay 85% of the cost of care, with you paying the remaining 15% of costs, are actuarially equivalent.

On your state's Marketplace, you'll be able to compare a few plans with the same actuarial value. Their cost-sharing and benefits may differ, but their overall value is the same in actuarial equivalent plans. Even though the value is the same, actuarial equivalent plans may still have different premiums. When you're choosing a health plan, look at the costs but also make sure the plans cover the benefits that are most important to you. 

On the Marketplace, health plans are divided into tiers based on their actuarial value. A bronze plan pays an average of 60% of your eligible medical costs; silver 70%; gold 80%; and platinum 90%.

WebMD Medical Reference Reviewed by Sarah Goodell on June 21, 2021
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