Outreach from State-Based Marketplaces Increased 2022 ACA Enrollment

October 26, 2022 - State-based marketplaces employed several outreach methods during the 2022 open enrollment period to boost health plan enrollment among uninsured individuals, including data-based efforts and culturally appropriate strategies, a Commonwealth Fund issue brief found.

In 2021, the American Rescue Plan Act (ARPA) introduced premium subsidies for people seeking healthcare coverage on the Affordable Care Act (ACA) marketplace. While the subsidies helped marketplace enrollment reach a record high during the 2022 open enrollment period, many uninsured individuals were still unaware of the financial assistance.

Outreach strategies, including advertising campaigns and personal assistance, can help increase enrollment rates by ensuring individuals understand their health plan options.

Researchers surveyed the 21 state-based ACA marketplaces to determine their outreach strategies during the 2022 open enrollment period. The findings reflect responses from 17 of the state-based marketplaces.

Most marketplaces increased investments in advertising and other efforts to broadcast information about the open enrollment period. Respondents reported raising their advertising budget for television, radio, and print ads to promote enrollment.

In addition, more than half of the state-based marketplaces increased their budget for enrollment assisters, who offer one-on-one help to consumers during the enrollment process.

Some state-based marketplaces also received federal grants that helped fund enrollment efforts. For example, the modernization grants authorized under ARPA allocated $20 million for state-based marketplaces to modernize or update any system, program, or technology. New York’s marketplace used the grant to fund advertising and translations of messaging related to ARPA and open enrollment.

All state-based marketplaces that participated in the survey extended their open enrollment period beyond 45 days. Sixteen of the marketplaces extended the period into the beginning of the plan year, allowing consumers the option to enroll in a more affordable plan after receiving their first bill.

Respondents reported that their outreach strategies regarding the ARPA premium subsidies and affordable plan options helped boost enrollment. For example, Colorado saw a 21 percent increase in new enrollees and attributed this to consumers who returned to the marketplace after thinking they could not afford coverage.

Maryland, which saw nearly 50 percent more new enrollees, said working with social media influencers to reach consumers newly eligible for subsidies helped the state increase enrollment.

State-based marketplaces also used data on the uninsured to craft outreach strategies. For example, Washington identified geographic areas with high uninsured rates and created advertising based on demographics and preferred media outlets. Rhode Island also distributed flyers, brochures, and posters in regions likely to have uninsured residents.

Marketplaces were culturally conscious in their outreach efforts, the survey found. As language barriers can prevent people from signing up for health insurance coverage, state-based marketplaces employed efforts to limit these obstacles.

Rhode Island distributed all outreach materials in English and Spanish and posted flyers at Spanish-speaking religious organizations.

Additionally, state-based marketplaces offered linguistically appropriate enrollment assistance, such as interpreters during virtual one-on-one enrollment assistance meetings. Minnesota translated advertisements for Hmong, Somali, and Spanish speakers that detailed how assisters could help consumers in their preferred language.

Culturally and linguistically appropriate outreach can help address knowledge gaps and improve health literacy among underserved populations. Nevada’s marketplace reported that community partnerships and radio broadcasts improved outreach impact in Latino and Hispanic communities. In addition, Colorado developed representative material and invested in assistance resources tailored toward LGBTQ, Latino and Hispanic, Black, and rural communities.

State-based marketplaces partnered with state agencies and healthcare providers to reach uninsured individuals, the survey found. Marketplaces also advertised at pharmacies, hospitals, health clinics, and COVID-19 vaccination and testing sites.

When the COVID-19 public health emergency ends and states begin Medicaid redeterminations, the ACA marketplace may see a surge of new enrollees as beneficiaries become ineligible for Medicaid coverage.

“In addition to protecting and extending coverage gains of the ARPA’s subsidy expansion in future open enrollment periods, lessons learned during the marketplaces’ most successful enrollment season provide insight on how to improve take-up among newly marketplace-eligible consumers,” the brief concluded.