CMS Issues Draft 2025 Actuarial Value Calculator and Methodology; Comments Due January 2

The Centers for Medicare and Medicaid Services (CMS) Department of Health and Human Services (HHS) has issued the proposed 2025 actuarial value (AV) calculator and methodology. HHS requires use of an AV calculator by issuers of non-grandfathered health insurance plans offered in the individual and small group markets, both inside and outside of the Affordable Insurance Exchanges for the purposes of determining levels of coverage.

The Affordable Care Act stipulates that AV be calculated based on the provision of essential health benefits (EHB) to a standard population. The statute groups health plans into four tiers: bronze, with an AV of 60 percent; silver, with an AV of 70 percent; gold, with an AV of 80 percent; and platinum, with an AV of 90 percent.

The draft 2025 AV calculator does not affect any 2024 plans and will only be applicable for 2025 plans.