Effect of Email Nudges on Plan Switching and Healthcare Utilization Among Unemployment Insurance Recipients

NCT05891418 | Completed

• 1 other identifier: 022023
• Study Type: interventional
• Target: 42,470
• Locations: 1 country
• Sites: 1

Brief Summary

In March 2021, President Biden signed into law the American Rescue Plan Act of 2021 (ARP), a landmark federal economic relief and stimulus package designed to provide support to Americans hit by the economic recession brought about by the COVID-19 global pandemic. The law provides increased federal premium tax credits (PTC), and ensures that consumers will pay no more than 8.5 percent of household income on health insurance premiums in 2021 and 2022, if enrolled through an Affordable Care Act marketplace like Covered California. The ARP also provides additional PTC and cost-sharing reduction (CSR) benefits to eligible marketplace enrollees who report receiving unemployment insurance benefits (UIB) for at least one week in 2021. Under the law, for 2021 only, Covered California consumers will have their household income level treated as if it were at 138.1 percent of the federal poverty level (FPL), regardless of their projected annual income, which will make them eligible for a Silver 94 plan, and which offers the greatest value on cost-sharing benefits. But in order to access those cost-sharing benefits, households must be in silver tier plans, but over 40,000 were not. This project's goal is to assess the effects of an informational email on plan switching into Cost Sharing Reduction Silver plans and downstream healthcare utilization. The project's research design is a randomized intervention among approximately 42,500 enrolled households with an email address in non-silver tier plans. The investigators randomly assigned to either two informational emails or to a no email control group. The investigators then collected administrative data to examine plan switching behavior and healthcare utilization among households in the study.

Conditions

Health Behavior

Keywords

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

Outcome Measures

Primary Outcomes (5)

• Cost-Sharing Reduction Silver Enrollment

  Percent of households enrolled in a Cost-Sharing Reduction Silver Plan

  1 month

• Office Visit

  Percent of households with an office visit

  6 months

• Prescription drug use

  Percent of households with a prescription drug fill

  6 months

• Emergency room visit

  Percent of households with an emergency room visit

  6 months

• Hospitalization

  Percent of households with a hospitalization

  6 months

Study Arms (2)

Control Group with a standard eligibility notice

EXPERIMENTAL

Control group was assigned to receive no email outreach in June and July beyond an eligibility redetermination notice.

Behavioral: Standard notice of eligibility determination

Treatment group with a standard eligibility notice and assigned two email nudges

EXPERIMENTAL

Assigned to receive an eligibility redetermination notice along with two informational emails about the benefits of Cost-Sharing Reduction Silver plans.

Behavioral: Two informational emails with plan information

Interventions

Two informational emails with plan information BEHAVIORAL

Informational emails about the benefits of Cost-Sharing Reduction Silver plans.

Treatment group with a standard eligibility notice and assigned two email nudges

Standard notice of eligibility determination BEHAVIORAL

No extra outreach during intervention period.

Control Group with a standard eligibility notice

Eligibility Criteria

• Age: 0 Years - 74 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• Has email address, in a non-silver plan and reported unemployment insurance in 2021

You may not qualify if:

• In a silver plan, no email address

Sponsors & Collaborators

• Office of Evaluation Sciences: lead

Study Sites (1)

Covered California

Sacramento, California, 95815, United States

Location

Related Publications (1)

• Lovchikova M, Feher A, Lian L. Health Plan Switching and Health Care Utilization: A Randomized Clinical Trial. JAMA Health Forum. 2024 Mar 1;5(3):e240324. doi: 10.1001/jamahealthforum.2024.0324.

  PMID: 38551588 DERIVED

MeSH Terms

Conditions

Health Behavior

Condition Hierarchy (Ancestors)

Behavior

Study Officials

• Andrew Feher, PhD

  Covered California

  PRINCIPAL INVESTIGATOR

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: February 14, 2023
• First Posted: June 6, 2023
• Study Start: June 25, 2021
• Primary Completion: December 31, 2021
• Study Completion: December 31, 2021
• Last Updated: June 6, 2023

Record last verified: 2023-06

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL
• 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)