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

Study Overview
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Brief Summary
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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.

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

Conditions
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Health Behavior

Intervention / Treatment
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* Behavioral: Emails and letter intervention
* Behavioral: Control group


Participation Criteria
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Eligibility Criteria
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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: -
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Control<br>Households in the control group did not receive any messages during the intervention period from June 2021 to August 2021 | Behavioral: Control group<br>* No outreach during the intervention period.<br>|
| Experimental: Generic Outreach<br>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<br>* Emails and letters for households assigned to the treatment group<br>|
| Experimental: Personalized Outreach<br>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<br>* Emails and letters for households assigned to the treatment group<br>|

What is the study measuring?
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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 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Affordable Care Act, randomized controlled trial, nudge, American Rescue Plan