CMS Issues Draft 2023 Actuarial Value Calculator and Methodology

The Centers for Medicare and Medicaid Services (CMS) Department of Health and Human Services (HHS) issued the proposed 2023 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 2020 AV calculator does not affect 2022 plans and is only applicable for 2023 plans.

Comments are due January 30, 2022.


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