AV Calculator
Methodology
The Basirix AV Calculator computes a plan’s actuarial value the way the government does — by reproducing the official CMS methodology in code — and shows its work. Here’s what that means.
What actuarial value means
Actuarial value (AV) is a single percentage that summarizes how much of a typical person’s covered medical costs a health plan pays. Across a standard population, a 90% plan pays about 90% of those costs and the member pays the rest; a 60% plan pays about 60%. It measures a plan’s cost-sharing generosity — deductible, copays, coinsurance, out-of-pocket maximum — not the premium, the network, or any one person’s actual bill.
The Affordable Care Act uses AV to define the metal tiers:
| Metal | Actuarial value |
|---|---|
| Bronze | ~60% |
| Silver | ~70% |
| Gold | ~80% |
| Platinum | ~90% |
The CMS AV Calculator
Actuarial value isn’t estimated by eye or by rule of thumb. Each year the Centers for Medicare & Medicaid Services (CMS) publishes an official AV Calculator. It combines two things:
- Continuance tables — CMS-published distributions of expected annual medical spending for a standard population; and
- the plan’s cost-sharing — deductible, out-of-pocket maximum, copays, coinsurance, and prescription-drug tiers.
For a given plan design, it integrates plan-paid spending across that distribution and returns the actuarial value. Health-insurance issuers are required to use this calculator to determine a plan’s metal level.
How Basirix mirrors it
The Basirix AV Calculator is a faithful, from-scratch reproduction of the CMS methodology in code — the same continuance tables, the same calculation — with no spreadsheet involved. We built it directly from CMS’s published AV Calculator Methodology documents and the official continuance tables, and we validate it against the real CMS calculator: our engine reproduces the official calculator’s answers to four decimal places across CMS’s own test plans, for both the current and next methodology years.
Reproducing the calculation, rather than treating it as a black box, is what lets the tool do more than print a number:
- it shows which benefits drive the value — why a plan lands where it does;
- it runs instant what-if comparisons between two plan designs; and
- it computes the standard coverage examples below.
The three coverage examples
Alongside the actuarial value, Basirix computes the three clinical scenarios CMS defines — Having a Baby, Managing Type 2 Diabetes, and a Simple Fracture — the same standardized examples printed on every plan’s Summary of Benefits and Coverage. They translate the headline percentage into what you’d actually pay in common situations, computed by the same engine.
What this is — and isn’t
- It is a rigorous comparison and analysis tool — an actuarial value you can audit, traced to the CMS methodology and the plan’s own benefit design.
- It is not a certified or filed actuarial value. The official metal-level determination for a health plan is produced by CMS’s own calculator; Basirix reproduces the same mathematics for analysis and comparison, not for a regulatory filing.
- It is not insurance, a quote, a bill, or a recommendation. Actuarial value is one input among several — it doesn’t capture network, formulary, premium, or provider access. For a determination you intend to rely upon, consult a qualified actuary or your benefits advisor.
Transparency
Every figure is reproducible from its inputs and the cited CMS continuance tables. Results reflect in-network cost-sharing — the basis CMS uses. Where a plan’s Summary of Benefits doesn’t state something the calculation needs, Basirix applies a disclosed default and flags it — never a silent guess, and the assumptions are shown with every result. That transparency is the point: an actuarial value you can check, not one you have to take on faith.