Two plans with the same actuarial value can differ in cost-sharing features such as deductibles and copays.

Two plans with the same actuarial value can differ in cost-sharing features such as deductibles and copays.

• A. True
• B. False
• C. Not specified
• D. Sometimes

Answer: (A)

Actuarial value is the average share of health care costs a plan pays for covered benefits, using standard assumptions about utilization. It measures how generous the plan is on average, not the exact way costs are split across services or when they’re paid. Because AV is an average across many scenarios, two plans can be structured with different deductibles, copays, and coinsurance yet end up paying the same overall portion of costs on average. One plan might shift more cost to the deductible while offering low per-service charges, while another might have a higher deductible forgiveness or different per-service costs, but the standard valuation still yields the same AV. The distribution of who pays for what can differ while the average percentage paid by the plan remains the same.

Actuarial value is the average share of health care costs a plan pays for covered benefits, using standard assumptions about utilization. It measures how generous the plan is on average, not the exact way costs are split across services or when they’re paid.

Because AV is an average across many scenarios, two plans can be structured with different deductibles, copays, and coinsurance yet end up paying the same overall portion of costs on average. One plan might shift more cost to the deductible while offering low per-service charges, while another might have a higher deductible forgiveness or different per-service costs, but the standard valuation still yields the same AV. The distribution of who pays for what can differ while the average percentage paid by the plan remains the same.