As the Supreme Court hears oral arguments today about the fate of the Affordable Care Act (ACA) in the case of California vs. Texas, state-based health insurance marketplaces (SBMs) are actively connecting consumers to health insurance coverage during the annual open enrollment period that launched Nov. 1.
While the court case casts a shadow of uncertainty over the ACA, COVID-19 and the ensuing economic crisis have increased the need for affordable coverage and forced SBMs to alter their consumer engagement strategies. Using lessons learned from their recent special enrollment periods (SEPs) to meet consumers’ coverage needs, SBMs are adapting outreach and enrollment efforts in recognition of social distancing standards.
Targeted Messaging to Promote Affordability and Accessibility
Recognizing the severe economic challenges many Americans face because of the pandemic, SBMs are carefully framing messages showcasing the affordability and accessibility of qualified health plan (QHP) coverage. As job and income losses make more individuals eligible for premium subsidies available through marketplaces, SBMs have adopted simple, straightforward messaging.
- California’s open enrollment slogan, “This way to health insurance” conveys the exchange is available to provide a path to coverage for all consumers.
- Minnesota’s promotion acknowledges the confusion that consumers may experience as they move from employer-sponsored insurance (ESI) and into the individual market with this targeted message: “UNsure about health insurance options? BEsure. MNsure.org.”
SBMs leaders recognize that access to high-quality, comprehensive health coverage is crucial to maintaining the health of individuals and communities, especially as thousands continue to be affected by COVID-19. SBMs are employing the following strategies to remind consumers that health coverage can provide peace of mind and critical care in the midst of the pandemic.
- Washington, DC has distributed masks printed with the message, “Get Covered, Stay Covered” to existing customers, contact tracers, and community leaders to emphasize that both forms of “coverage” — masks and health insurance – are necessary to maintain health during a pandemic. DC Health Link branding will also be incorporated into social distancing signs across the district.
- Massachusetts is highlighting that COVID-19 testing and treatment is covered by most marketplace plans and is promoting the “security” that comes when individuals know they and their families have coverage in the event of an emergency.
In addition to targeting messages to the uninsured, SBMs leaders recognize their existing customers may be vulnerable to losing coverage, especially because of changes in income or life circumstance that may change the amount of subsidies they are eligible for. This includes extreme fluxuations due to changes in employment status and changes in unemployment insurance (UI) payments. To ensure that customers remain enrolled in a comprehensive health plan, SBMs have utilized targeted email blasts, social media advertisements, and text messages to encourage consumers to update any change in their income or employment status — which could result in increased financial assistance or eligibility for Medicaid. SBMs are also encouraging consumers to remain in contact with their marketplaces as their circumstances change to ensure that the enrollees remain properly enrolled in coverage.
- Idaho has shifted its advertising budget slightly to allocate more funds to digital media, which generates more website traffic than traditional media. However, Idaho will still invest significant resources into traditional media sources to reach consumers in rural areas who have limited access to internet services.
- Washington State has collaborated with local newspapers to create customized and regionally relevant content. These media partners will feature articles, dedicate newsletter content, and display advertisements to draw attention to open enrollment.
Adjusting In-Person Outreach for a Socially Distanced World
To adhere to social distancing restrictions, SBMs have transitioned most of their outreach efforts to virtual platforms and now offer very limited in-person events and consumer assistance. SBMs will offer virtual outreach events through Zoom, Facebook Live, and YouTube to help familiarize consumers with the coverage options and financial assistance available through the marketplace. To focus attention to these events, SBMs have leveraged partnerships with government agencies, faith-based groups, schools, and community organizations that have served as direct community touch points throughout the pandemic.
To maximize their outreach efforts, several states have elected to use consumer data to identify and reach consumer groups that would most likely benefit from marketplace coverage.
- Washington State has partnered with its Department of Financial Management to develop a map identifying communities with high rates of uninsurance to help inform the exchange about where outreach is needed.
- In Minnesota, demographic data is utilized to target social media advertisements and website banners to reach individuals who are most likely to be uninsured.
- Maryland’s Easy Enrollment program, which allows consumers to use the marketplace to estimate eligibility for coverage, has produced a list of over 40,000 consumers who have indicated that they are interested in learning more about coverage through the marketplace.
SBMs have also worked closely with their navigators and community partners to develop strategies to provide secure virtual enrollment assistance. Direct consumer assistance has been proven to significantly increase the likelihood that an individual will complete the enrollment process — particularly among low-income individuals and people of color. SBMs have adopted the following strategies to provide personalized enrollment assistance in a COVID-19 environment.
- Connecticut is hosting several virtual enrollment fairs during October and November. During these events, a representative helps consumers walk through the enrollment process with a screen-share feature so both can view enrollment forms together.
- Massachusetts has allocated additional funds to enable navigators to offer limited in-person assistance in place of walk-in centers. While navigators are not able to accept and process documents and payments, they can help customers with the application process.
- Nevada is scheduled to host a series of Facebook Live events with staff available to answer consumer questions and provide real-time enrollment assistance.
- In anticipation of their first open enrollment period as SBMs, New Jersey and Pennsylvania tripled their navigator programs to ensure that consumers would have the accessible support they need to navigate the new platform.
Strategies to Connect with the Recently Unemployed
With millions of Americans losing employment due to the pandemic, SBMs have taken steps to connect with individuals who have lost employer-sponsored insurance (ESI) coverage. A recent Commonwealth Fund study found that as of June 2020, 7.7 million Americans lost jobs with ESI as a result of the pandemic. Experts expect that unemployment and uninsurance will continue to rise as job losses become permanent and temporary policies, like grace periods granted to those unable to pay their monthly insurance premiums, expire. The SBMs officials acknowledge that many consumers who have lost ESI may be exploring coverage options on the individual market for the first time. To ease confusion and stress, SBMs have utilized the following strategies to connect the recently unemployed to coverage.
- New Jersey’s SBM has coordinated with the Department of Labor (DOL) to include a link to the SBM website within DOL’s consumer portal so individuals are reminded of their health coverage options when they check the status of their unemployment claims.
- Colorado has purchased targeted advertisements to reach those who search for Consolidated Omnibus Budget Reconciliation Act (COBRA) so consumers can compare cost and coverage options across programs.
- The Washington Health Benefit Exchange is telling consumers, “Filing for unemployment benefits? Visit the exchange to stay covered” to remind them to seek a new form of coverage after losing their ESI.
- Nevada includes informational pamphlets about open enrollment in direct mailers sent to individuals who have filed for unemployment. In addition, the state’s Department of Unemployment will share open enrollment information on its social media and web pages.
In addition to coordinating with their states’ labor and employment departments, several SBMs have bolstered strategies to connect with consumers who have recently been terminated by their employer. By monitoring Worker Adjustment and Retraining Notices, which require certain employers to give advance notice of mass layoffs, SBMs are able to identify employers that are about to conduct large-scale lay-offs and then work with their human resource departments to tailor an outreach strategy about marketplace coverage options. In many cases, consumers may access lower-cost coverage through the marketplace than through the COBRA coverage that employers are required to offer.
The open enrollment season for most states runs through Dec. 15, 2020, but several SBMs have extended their deadlines. Explore NASHP’s chart and interactive map, Where States Stand on Exchanges, for more information and links to SBM websites.