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Regulatory Updates provide quick access to employee benefit regulations, ruling and other guidance released by governmental agencies in the U.S. and Canada.

Regulations may be included in Today’s Headlines which is emailed to International Foundation members each business day. Inquiries should be directed to the Benefits Knowledge Center at (888) 334-3327, option 5 or [email protected].

CMS Issues Updated Final 2026 Actuarial Value Calculator and Methodology

Sep 9, 2025, 15:43 by Amanda Wilke

The Department of Health and Human Services (HHS) issued an updated final 2026 actuarial value (AV) calculator and methodology.

(updated September 9, 2025)

The Department of Health and Human Services (HHS) issued its final 2026 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 final 2026 AV Calculator is available for download. The 2026 AV calculator does not affect 2025 plans and is only applicable for 2026 plans.

(posted October 16, 2024)