Which factor primarily determines the actuarial value category of a health plan?

• A. The plan’s monthly premium.
• B. The percentage of total medical costs paid by the plan for a standard population.
• C. The deductible amount.
• D. The network size.

Answer: (B)

Actuarial value category shows how much of the typical medical costs a plan pays for a standard population after cost-sharing. In other words, it’s defined by the plan’s share of total medical costs covered, not by what the plan charges in premiums or how large its provider network is. The deductible and other cost-sharing features influence exactly out-of-pocket costs for individuals, but the category itself is determined by the overall percentage the plan pays of total costs. For context, ACA categories map to roughly bronze around 60%, silver about 70%, gold around 80%, and platinum near 90% of costs paid by the plan. So the main determinant is the plan’s percentage of total medical costs paid for a standard population.