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AHIP AHM-520 Exam - Topic 4 Question 95 Discussion

The Northwest Company offers its employees the option of choosing to receive their healthcare benefits from an HMO or from a traditional indemnity plan. The premiums for the HMO are lower than for the traditional indemnity plan. In this situation, it is correct to assume that:1. Individual low utilizers are more likely to enroll in the traditional indemnity plan2. Individual high utilizers are more likely to enroll in the HMO
D) Neither 1 nor 2
A) Both 1 and 2
B) 1 only
C) 2 only

AHIP AHM-520 Exam - Topic 4 Question 95 Discussion

Actual exam question for AHIP's AHM-520 exam
Question #: 95
Topic #: 4
[All AHM-520 Questions]

The Northwest Company offers its employees the option of choosing to receive their healthcare benefits from an HMO or from a traditional indemnity plan. The premiums for the HMO are lower than for the traditional indemnity plan. In this situation, it is correct to assume that:

1. Individual low utilizers are more likely to enroll in the traditional indemnity plan

2. Individual high utilizers are more likely to enroll in the HMO

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Suggested Answer: D

by Daniel at Aug 22, 2024, 08:59 PM

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Bettye
8 months ago
Traditional plans usually attract those who want more control over their care.
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Claribel
8 months ago
Totally agree, high utilizers need more coverage, HMO fits!
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Valentin
9 months ago
Wait, are high utilizers really going for the HMO? Seems odd.
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Mabelle
9 months ago
I think low utilizers would prefer the indemnity plan for flexibility.
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Carlton
9 months ago
HMO premiums are definitely lower, so that makes sense.
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Marnie
9 months ago
I'm a bit confused about the first statement. Wouldn't low utilizers be more cost-conscious and therefore choose the cheaper HMO?
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Virgina
10 months ago
This question feels familiar; I think we practiced something similar where we talked about risk selection in health plans.
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Allene
10 months ago
I think high utilizers would definitely lean towards the HMO because of the lower premiums and better access to care, but I can't recall if that's always true.
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Vincenza
10 months ago
I remember discussing how low utilizers might prefer the traditional plan for more flexibility, but I'm not entirely sure if that's the case here.
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In
10 months ago
This is a classic case of adverse selection. The low-risk individuals will self-select into the traditional indemnity plan, while the high-risk individuals will choose the HMO with the lower premiums. I'm confident I can apply this concept correctly on the exam.
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Rene
10 months ago
Okay, I think I've got this. The key is that the HMO premiums are lower, so the high utilizers will be more likely to choose the HMO to get better coverage at a lower cost. The low utilizers will prefer the traditional indemnity plan since they won't need the extra benefits of the HMO.
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Lavonna
10 months ago
Hmm, I'm a little unsure about this one. I know adverse selection is a key concept, but I'm not totally confident in applying it to this specific scenario. Let me re-read the question carefully.
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Mireya
10 months ago
This seems like a straightforward question about adverse selection in healthcare plans. I'll need to think through the incentives for low and high utilizers to choose between the HMO and indemnity plan.
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Loren
10 months ago
This question seems pretty straightforward. I'll focus on the key points about the Content Service and normalization rules.
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Carmelina
2 years ago
D) Neither 1 nor 2? What kind of trick question is this? Of course individual risk profiles would determine their plan choice. I'm not falling for that one!
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Starr
2 years ago
Hey, if I'm a high utilizer, I'm definitely going for the traditional plan! Why would I willingly sign up for the HMO plan and have to jump through hoops to see a specialist? A) Both 1 and 2 is the way to go.
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Latrice
2 years ago
I see your point, Tegan. So, the answer could be both 1 and 2.
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Tegan
2 years ago
But wouldn't individual high utilizers benefit more from the comprehensive coverage of the HMO?
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Jestine
2 years ago
I'm going with C) 2 only. It just makes sense that people who expect to use more healthcare services would choose the HMO to get the lower premiums, even if it means more restrictions.
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Janey
2 years ago
I think I would go with A) Both 1 and 2, because low utilizers might prefer the traditional indemnity plan for more flexibility.
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Charlene
2 years ago
I agree with you, C) 2 only seems like the logical choice for high utilizers.
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Barrett
2 years ago
I agree with Tom, the lower premiums would be more attractive to low utilizers.
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Tom
2 years ago
I think individual low utilizers would prefer the traditional indemnity plan.
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Dwight
2 years ago
I think the correct answer is B) 1 only. Low utilizers would logically choose the cheaper HMO plan, while high utilizers would be more likely to opt for the traditional indemnity plan with its higher premiums but wider coverage.
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Truman
2 years ago
That makes sense, so the correct answer is B) 1 only.
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Nida
2 years ago
But wouldn't high utilizers want the wider coverage of the traditional plan?
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Dell
2 years ago
I agree with you, low utilizers would definitely go for the cheaper option.
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