ACA Risk Management & Mitigation 3

Question 1

The ACA's risk adjustment model uses Hierarchical Condition Categories (HCCs) primarily to:

Accepted Answer

Predict relative medical costs based on enrollee diagnoses

Answer

HCCs group diagnosis codes to estimate each enrollee's expected medical costs, which feeds into the plan's overall risk score.

Question 2

Which factor is NOT used in calculating a plan's risk score under the ACA risk adjustment methodology?

Accepted Answer

Premium amount charged by the plan

Answer

Risk scores are based on enrollee demographics and health status (HCCs), not on the premiums the plan charges.

Question 3

A 'silver loading' strategy employed by some states after the CSR funding cuts is best described as:

Accepted Answer

Adding CSR costs only to silver plan premiums to inflate benchmark subsidies

Answer

Silver loading concentrates CSR cost increases on silver plans, inflating the benchmark premium used to calculate APTC and benefiting subsidized enrollees.

Question 4

Under ACA rules, the maximum out-of-pocket limit mitigates financial risk for enrollees primarily by:

Accepted Answer

Capping total annual cost-sharing for covered in-network services

Answer

The annual out-of-pocket maximum stops enrollees from paying unlimited cost-sharing, protecting against catastrophic financial exposure for in-network covered services.

Question 5

Which ACA mechanism specifically reduces financial risk for lower-income marketplace enrollees by reducing deductibles and copayments?

Accepted Answer

Cost-Sharing Reductions (CSRs)

Answer

CSRs reduce out-of-pocket costs for eligible silver plan enrollees with incomes between 100–250% FPL by requiring insurers to offer enhanced actuarial value.

(ACA) Affordable Care Act Certified Practice Test

(ACA) Affordable Care Act Certified Practice Test

ACA Risk Management & Mitigation 3