How to Drive Enrollment in the ACA Health Plan Marketplaces

June 26, 2018 - Payers and states wishing to increase enrollment in the ACA health plan marketplaces should  create targeted advertisements, benchmark silver-tier plans as their primary exchange plan, and help consumers navigate health plan purchases, according to an Urban Institute report.

National enrollment in ACA health plans dropped slightly between 2017 to 2018, the report says.

However, payers that used social media to help members enroll in plans and moved affordable health plans to state-based exchanges saw significant increases in ACA enrollment.

How can payers learn from successes in states including Rhode Island, New York, and Washington to produce higher enrollment rates in ACA marketplace health plans?

Silver-loading and using silver-tier plans as the primary exchange plan

States that saw increased enrollment used a practice called “silver-loading” to drive up their numbers. Silver-loading is when a state directs payers to raise silver plan premiums so that more individuals can earn premium subsidies, thereby attracting more beneficiaries to these options.

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In Rhode Island, the state attributed the practice of silver-loading to a 12.2 percent increase in ACA health plan enrollment as many beneficiaries received premium assistance. Washington state also experienced a greater number of beneficiaries enroll in ACA plans by using silver-loading practices.

“Adding the costs of CSRs into silver marketplace premiums alone maximizes the size of advanced premium tax credits available to people with incomes up to 400 percent of federal poverty level (FLP) because the size of the credit is linked to the premium for the second-lowest-cost silver marketplace plan offered in a consumer’s geographic area (the ‘benchmark’ plan),” the team said.

Silver-loading can help states and payers that are most affected by the loss of CSRs. Individuals in states that have been dependent on the CSRs for controlling costs, like West Virginia, saw premium increases when governments did not silver-load their health plans.

“West Virginia did not silver-load, so premium tax credits were not maximized for enrollees as they were in many other states,” the Urban Institute said. “The average premium of the lowest-priced silver plan in West Virginia increased by 16.9 percent over last year, and the average lowest-priced gold plan premium increased by 24.3 percent.”

Targeting advertisements and extending open enrollment to ACA enrollees  

Creating targeted health plan advertisements across multiple channels and extending open enrollment dates to shoppers are key strategies for making sure potential beneficiaries understand when to enroll, and what their best plan options will be.

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In New York, insurance officials established $7 million in funding for ACA advertising campaigns, and $27 million in funding to the ACA Navigators Program.  These actions helped the state increase ACA enrollment by 4.2 percent in 2018.

New York payers created campaigns for social media websites, billboards, television ads, and community events to reduce public confusion about the exchanges. The state and payers developed these advertising campaigns to help connect individuals to the Navigator program through personalized outreach efforts.

“The state’s marketplace sent 1.2 million personalized emails to people who had created marketplace accounts to remind them to enroll in 2018 coverage, and marketplace representatives participated in nearly 470 events this year,’ the Urban Institute said.

Similar advertising efforts in Washington and Rhode Island bolstered ACA enrollment in those regions, as well.

Washington payers and insurance administrators used social media sites, including Facebook and Twitter, to generate discussion and share information with new and returning beneficiaries. Washington’s health plan navigators also engaged members in multiple ethnic communities where insurance rates were low.

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The state also opened six brick-and-mortar storefronts where individuals could enroll in health plans.  The storefronts saw brisk activity, according to state officials.

In Rhode Island, payers and the state relied heavily on social media, and even cut traditional advertising efforts, to connect politically active members to discussions about the ACA and the exchanges.

In contrast, when Louisiana significantly cut its advertising activities, the state saw a 23.5 percent decline in its ACA enrollment numbers.

“A few interviewees [state officials and insurance brokers] thought that the reduction in federally funded marketplace advertising—especially online ads targeted at young and healthy consumers—hurt enrollment numbers,” the Urban Institute said. “Some reported that the state government had funded advertising campaigns around Medicaid expansion, especially last year, but not around marketplace open enrollment.”

Offering health plan shopping and navigation tools

ACA enrollment may increase if consumers have access to more intuitive shopping tools and digital navigation options that can help them pick the right plans for their needs.

In Washington, ACA enrollment increased by 7.8 percent due to state efforts to improve consumer shopping experiences and educate members about health plan options.

Washington’s Insurance Commissioner issued several guidance documents and press releases about the federal government’s decision to cut the CSRs, and instructed individuals on how to enroll in new ACA plans.

Washington’s insurance commission also developed a digital shopping tool, called Smart PlanFind, to help members search for plans based on their prescriptions, preferred providers, and predicted number of clinical visits for the year.

In Rhode Island, state officials worked with ACA Navigators to help individuals enroll faster in health plans and made improvements to the marketplace’s digital shopping experiences. Rhode Island also improved consumer satisfaction with digital health plan shopping on the exchanges by removing glitches in its digital shopping dashboards.  

Consumer confusion over shopping for health plans, especially as the ACA undergoes significant alterations, can be detrimental to the enrollment process, as West Virginia quickly found out.

“Interviewees reported that call centers heard from many [West Virginia] residents panicked about whether their insurance would become unaffordable or disappear, confused about whether they were required to purchase insurance this year, and uncertain about whether the ACA was still in effect,” the Urban Institute said.

State governments have the ability to improve ACA health plan market conditions, even as the ACA faces increasing political challenges. The team concluded that states will have to make a series of important decisions in the near future they want to effectively drive ACA enrollment.

“According to a recent Kaiser poll, more than half of Americans think that the ACA marketplaces are ‘collapsing.’ But some states are proactively taking steps to protect market stability in the face of changing regulations,” the team concluded.

“As states prepare for 2019, they must decide whether and how to continue to bolster the marketplaces, despite federal efforts to limit the ACA’s reach,” the Urban Institute said.