Actuarial value, calculated the way CMS does.
Compare any two plan designs in seconds — using CMS’s own AV calculator methodology. Free. No signup.
By using this calculator you agree to the Terms of Use.
In-network ⓘActuarial value is an in-network measure — it reflects what the plan pays for in-network care, the basis CMS uses. You enter in-network cost-sharing only. Out-of-network costs aren't part of AV — except emergency care, which by law is charged at in-network rates.AV Calculator · anchor vs alternate
How it works: enter each plan’s key numbers and hit Calculate — you’ll get each plan’s actuarial value (how much the plan pays) and three common situations. Why these fields? ⓘThese few inputs drive most of a plan’s actuarial value — deductible, out-of-pocket max, and the most-used care (visits, ER, hospital, Rx). The rest is a small slice we fill in with standard assumptions (see “We assume the following”).
The bottom line
Enter both plans and press Calculate to compare them.
Plan A — Anchor
The plan pays
—
Out-of-pocket maxInd$Fam$
DeductibleInd$Fam$
Default coinsurance (services not listed) ⓘApplies to services you don’t list below (lab, imaging, therapy, hospital facility). For each service you do enter, only that box applies — the two don’t stack. Set to 0% for a plan with no coinsurance.Treats services you didn’t list as fully covered after the deductible. For a truly copay-only plan (copays on those services too), treat the result as an approximation.%
Doctor visits
PCP$Deductible — Off: the deductible doesn’t apply to this benefit (the member pays just the cost-share). On: the member meets the deductible first, then pays the cost-share. Tap or click to switch.Add a coinsurance that applies after the copay — for a benefit priced “$500 copay, then 20%.” Leave it off if the benefit is just a copay.
Specialist$Deductible — Off: the deductible doesn’t apply to this benefit (the member pays just the cost-share). On: the member meets the deductible first, then pays the cost-share. Tap or click to switch.Add a coinsurance that applies after the copay — for a benefit priced “$500 copay, then 20%.” Leave it off if the benefit is just a copay.
Inpatient$Deductible — Off: the deductible doesn’t apply to this benefit (the member pays just the cost-share). On: the member meets the deductible first, then pays the cost-share. Tap or click to switch.Add a coinsurance that applies after the copay — for a benefit priced “$500 copay, then 20%.” Leave it off if the benefit is just a copay.
Outpatient surgery$Deductible — Off: the deductible doesn’t apply to this benefit (the member pays just the cost-share). On: the member meets the deductible first, then pays the cost-share. Tap or click to switch.Add a coinsurance that applies after the copay — for a benefit priced “$500 copay, then 20%.” Leave it off if the benefit is just a copay.
ER (emergency room)$Deductible — Off: the deductible doesn’t apply to this benefit (the member pays just the cost-share). On: the member meets the deductible first, then pays the cost-share. Tap or click to switch.Add a coinsurance that applies after the copay — for a benefit priced “$500 copay, then 20%.” Leave it off if the benefit is just a copay.
Prescriptions
Generic$Deductible — Off: the deductible doesn’t apply to this benefit (the member pays just the cost-share). On: the member meets the deductible first, then pays the cost-share. Tap or click to switch.Add a coinsurance that applies after the copay — for a benefit priced “$500 copay, then 20%.” Leave it off if the benefit is just a copay.
Brand$Deductible — Off: the deductible doesn’t apply to this benefit (the member pays just the cost-share). On: the member meets the deductible first, then pays the cost-share. Tap or click to switch.Add a coinsurance that applies after the copay — for a benefit priced “$500 copay, then 20%.” Leave it off if the benefit is just a copay.
Insulin (optional)
Plan B — Alternate
The plan pays
—
Out-of-pocket maxInd$Fam$
DeductibleInd$Fam$
Default coinsurance (services not listed) ⓘApplies to services you don’t list below (lab, imaging, therapy, hospital facility). For each service you do enter, only that box applies — the two don’t stack. Set to 0% for a plan with no coinsurance.Treats services you didn’t list as fully covered after the deductible. For a truly copay-only plan (copays on those services too), treat the result as an approximation.%
Doctor visits
PCP$Deductible — Off: the deductible doesn’t apply to this benefit (the member pays just the cost-share). On: the member meets the deductible first, then pays the cost-share. Tap or click to switch.Add a coinsurance that applies after the copay — for a benefit priced “$500 copay, then 20%.” Leave it off if the benefit is just a copay.
Specialist$Deductible — Off: the deductible doesn’t apply to this benefit (the member pays just the cost-share). On: the member meets the deductible first, then pays the cost-share. Tap or click to switch.Add a coinsurance that applies after the copay — for a benefit priced “$500 copay, then 20%.” Leave it off if the benefit is just a copay.
Inpatient$Deductible — Off: the deductible doesn’t apply to this benefit (the member pays just the cost-share). On: the member meets the deductible first, then pays the cost-share. Tap or click to switch.Add a coinsurance that applies after the copay — for a benefit priced “$500 copay, then 20%.” Leave it off if the benefit is just a copay.
Outpatient surgery$Deductible — Off: the deductible doesn’t apply to this benefit (the member pays just the cost-share). On: the member meets the deductible first, then pays the cost-share. Tap or click to switch.Add a coinsurance that applies after the copay — for a benefit priced “$500 copay, then 20%.” Leave it off if the benefit is just a copay.
ER (emergency room)$Deductible — Off: the deductible doesn’t apply to this benefit (the member pays just the cost-share). On: the member meets the deductible first, then pays the cost-share. Tap or click to switch.Add a coinsurance that applies after the copay — for a benefit priced “$500 copay, then 20%.” Leave it off if the benefit is just a copay.
Prescriptions
Generic$Deductible — Off: the deductible doesn’t apply to this benefit (the member pays just the cost-share). On: the member meets the deductible first, then pays the cost-share. Tap or click to switch.Add a coinsurance that applies after the copay — for a benefit priced “$500 copay, then 20%.” Leave it off if the benefit is just a copay.
Brand$Deductible — Off: the deductible doesn’t apply to this benefit (the member pays just the cost-share). On: the member meets the deductible first, then pays the cost-share. Tap or click to switch.Add a coinsurance that applies after the copay — for a benefit priced “$500 copay, then 20%.” Leave it off if the benefit is just a copay.
Insulin (optional)
For each benefit, choose what the member pays — a $ copay or a % coinsurance — then use the deductible switch to say whether the deductible applies. A few benefits are both — “$500 copay, then 20%,” most often the emergency room. Use add coinsurance on those rows.
What the member will pay
🍼 Having a baby
Anchor—
Alternate—
🩺 Managing type 2 diabetes
Anchor—
Alternate—
🦴 Simple fracture
Anchor—
Alternate—
Comparison estimates from a short input set — not certified actuarial values, a bill, or a quote. Values are in-network.