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

NCT05216458 | Completed

• 1 other identifier: 05272021
• Study Type: interventional
• Target: 44,000
• Locations: 1 country
• Sites: 1

Brief Summary

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.

Conditions

Health Behavior

Keywords

Affordable Care Act; randomized controlled trial; nudge; American Rescue Plan

Outcome Measures

Primary Outcomes (3)

• 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 Outcomes (1)

• Percent of households who logged into their online account

  Three months

Study Arms (3)

Control

EXPERIMENTAL

Households in the control group did not receive any messages during the intervention period from June 2021 to August 2021

Behavioral: Control group

Generic Outreach

EXPERIMENTAL

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

Personalized Outreach

EXPERIMENTAL

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

Interventions

Emails and letter intervention BEHAVIORAL

Emails and letters for households assigned to the treatment group

Generic Outreach; Personalized Outreach

Control group BEHAVIORAL

No outreach during the intervention period.

Control

Eligibility Criteria

• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

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

Sponsors & Collaborators

• Office of Evaluation Sciences: lead

Study Sites (1)

Covered California

Sacramento, California, 95815, United States

Location

MeSH Terms

Conditions

Health Behavior

Interventions

Control Groups

Condition Hierarchy (Ancestors)

Behavior

Intervention Hierarchy (Ancestors)

Epidemiologic Research Design; Epidemiologic Methods; Investigative Techniques; Research Design; Methods

Study Officials

• Andrew Feher, PhD

  Covered California

  STUDY DIRECTOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: PARTICIPANT
• Purpose: OTHER
• Intervention Model: PARALLEL
• Sponsor Type: FED
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Research Scientist

Study Record Dates

• First Submitted: December 31, 2021
• First Posted: January 31, 2022
• Study Start: May 27, 2021
• Primary Completion: August 31, 2021
• Study Completion: August 31, 2021
• Last Updated: January 31, 2022

Record last verified: 2022-01

Data Sharing

• IPD Sharing: Will share
• Shared Documents: SAP
• Time Frame: Data will be available with investigator support upon publication.
• Access Criteria: Replication data can be accessed via request to the primary investigator upon publication.

Locations

US (1)