ACA Risk Management & Mitigation 2

Question 1

Under the ACA's risk adjustment program, which entity collects and distributes payments among insurers in the individual and small group markets?

Accepted Answer

CMS on behalf of each state

Answer

CMS operates the permanent risk adjustment program and transfers funds from lower-risk to higher-risk plans in the individual and small group markets.

Question 2

An insurer's risk adjustment transfer amount is calculated based on the difference between its average actuarial risk and:

Accepted Answer

The state average actuarial risk

Answer

Risk adjustment transfers compare each plan's average actuarial risk against the statewide average to determine whether a plan pays into or receives from the pool.

Question 3

Which ACA provision was designed specifically to protect insurers from unexpectedly high claims in the first years of marketplace operation through a shared losses mechanism?

Accepted Answer

Risk Corridors

Answer

Risk corridors limited insurer losses by requiring HHS to cover a portion of losses exceeding a set threshold and collecting gains above another threshold.

Question 4

A health plan with a risk score BELOW the market average under the ACA risk adjustment program will most likely:

Accepted Answer

Pay into the risk adjustment pool

Answer

Plans with below-average risk scores (healthier enrollees) pay transfers to compensate plans with higher-risk enrollees.

Question 5

Under the ACA's temporary reinsurance program (2014–2016), which enrollees' claims primarily triggered reinsurance payments to insurers?

Accepted Answer

High-cost enrollees whose claims exceeded the attachment point

Answer

Reinsurance payments were triggered when an individual's claims exceeded a set attachment point, helping plans cover catastrophic costs.

(ACA) Affordable Care Act Certified Practice Test

(ACA) Affordable Care Act Certified Practice Test

ACA Risk Management & Mitigation 2