Using Personalized Letters and Emails to Increase Health Insurance Take-up and Improve Plan Choice Quality

Using Personalized Letters and Emails to Increase Health Insurance Take-up and Improve Plan Choice Quality in California's ACA Marketplace

With the passage of the American Rescue Plan (ARP) in March 2021, more consumers than ever before are now eligible for $0 -- or $1 per member per month (PMPM) in Marketplaces that include abortion coverage -- health insurance coverage across the ACA Marketplaces. But many individuals may not be aware of the new subsidies, or of their eligibility for Cost-Sharing Reduction (CSR) Silver plans. This project's goal is to examine whether personalized letters and email reminders can increase health insurance enrollment, CSR Silver take-up and $1 PMPM coverage.

Study Overview

• Status: Completed
• Conditions: Health Behavior
• Intervention / Treatment: Behavioral: Control group; Behavioral: Emails and letter intervention

• Study Type: Interventional
• Enrollment (Actual): 44000
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • California
    • Sacramento, California, United States, 95815
      • Covered California

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: ADULT; OLDER_ADULT; CHILD
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Submitted a Covered California application for the 2021 coverage year and found eligible for a $1 PMPM Enhanced Silver 94 plan

Exclusion Criteria:

-

Study Plan

How is the study designed?

Design Details

• Primary Purpose: OTHER
• Allocation: RANDOMIZED
• Interventional Model: PARALLEL
• Masking: SINGLE

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
EXPERIMENTAL: Control; Households in the control group did not receive any messages during the intervention period from June 2021 to August 2021	Behavioral: Control group; No outreach during the intervention period.
EXPERIMENTAL: Generic Outreach; Households in the generic outreach group were assigned to receive a letter and two email reminders in June 2021 and thereafter received the standard messages Covered California sends to prospective enrollees, which explain that nearly all Covered California members get subsidies to pay for health insurance and encourage them to explore their plan options using an online Shop & Compare tool. For the generic arm, the outreach materials described new financial assistance under the American Rescue Plan and noted the availability of plans as low as $1/month.	Behavioral: Emails and letter intervention; Emails and letters for households assigned to the treatment group
EXPERIMENTAL: Personalized Outreach; Households in the personalized outreach group were assigned to receive a letter and two email reminders in June 2021 and thereafter received the standard messages Covered California sends to prospective enrollees. For the personalized arm, the outreach explicitly informed the household that they were eligible for a $1/month CSR Silver 94 plan and described the benefits this plan confers. The outreach materials for the personalized group were not only designed to increase enrollment, but also to simplify the search process by providing households with a clear recommendation to pick a CSR Silver plan; this included highlighting the low out-of-pocket costs these plans provide when accessing care, a screenshot of what the plan would look like when they entered the shopping portal and peer comparison language that noted 9 out of 10 consumers like them choose CSR Silver plans	Behavioral: Emails and letter intervention; Emails and letters for households assigned to the treatment group

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percent of households enrolled in an ACA plan	Percent of households enrolled in an ACA plan based on Covered California administrative data	Three months
Percent of households who chose a CSR Silver plan	Percent of households in a CSR Silver plan based on Covered California administrative data	Three months
Percent of households who enrolled in a $1/month net-of-subsidy premium plan	Percent of households who enrolled in a $1/month net-of-subsidy premium plan based on Covered California administrative data	Three months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percent of households who logged into their online account	Percent of households who logged into their online account based on Covered California administrative data	Three months

Collaborators and Investigators

• Sponsor: Office of Evaluation Sciences
• Investigators: Study Director: Andrew Feher, PhD, Covered California

Study record dates

Study Major Dates

• Study Start (ACTUAL): May 27, 2021
• Primary Completion (ACTUAL): August 31, 2021
• Study Completion (ACTUAL): August 31, 2021

Study Registration Dates

• First Submitted: December 31, 2021
• First Submitted That Met QC Criteria: January 18, 2022
• First Posted (ACTUAL): January 31, 2022

Study Record Updates

• Last Update Posted (ACTUAL): January 31, 2022
• Last Update Submitted That Met QC Criteria: January 18, 2022
• Last Verified: January 1, 2022

More Information

Terms related to this study

• Keywords: randomized controlled trial; Affordable Care Act; nudge; American Rescue Plan
• Other Study ID Numbers: 05272021

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: The researchers are committed to sharing as much data as possible for replication, consistent with the privacy and security requirements of the state agency that govern the re-disclosure of the data.
• IPD Sharing Time Frame: Data will be available with investigator support upon publication.
• IPD Sharing Access Criteria: Replication data can be accessed via request to the primary investigator upon publication.
• IPD Sharing Supporting Information Type: SAP

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No