Using Direct Mail and Email Reminders to Reduce Choice Errors among ACA Enrollees

Last registered on July 05, 2021
View Trial History

Pre-Trial

Trial Information

General Information

Title
Using Direct Mail and Email Reminders to Reduce Choice Errors among ACA Enrollees
RCT ID
AEARCTR-0006950
Initial registration date
December 20, 2020

Initial registration date is when the trial was registered.

It corresponds to when the registration was submitted to the Registry to be reviewed for publication.

First published
December 21, 2020, 11:24 AM EST

First published corresponds to when the trial was first made public on the Registry after being reviewed.

Last updated
July 05, 2021, 9:31 PM EDT

Last updated is the most recent time when changes to the trial's registration were published.

Locations

Country
United States of America
Region

Primary Investigator

Name
Andrew Feher
Affiliation
Covered California
Contact Primary Investigator

Other Primary Investigator(s)

PI Name
Isaac Menashe
PI Affiliation
Covered California
Contact Investigator

Additional Trial Information

Status
Completed
Start date
2020-10-01
End date
2021-02-01
Keywords
Behavior, Health
Additional Keywords
Choice errors, Affordable Care Act
JEL code(s)
Secondary IDs
Abstract
Every year tens of thousands of Affordable Care Act (ACA) enrollees, who are eligible for Enhanced Silver plans, enroll in Gold or Platinum plans wherein they pay higher monthly premiums for a plan with lower actuarial value. This project's goal is to examine whether direct mail and email reminders can increase Enhanced Silver take-up among Covered California households enrolled in Gold or Platinum plans for the 2020 coverage year. Enrollment in choice error plans is common across different health insurance markets--including Medicare, employer-sponsored insurance and the ACA Marketplaces--and thus identifying ways to improve choice quality is of interest to policymakers both in California and nationwide.

External Link(s)

Registration Citation

Citation
Feher, Andrew and Isaac Menashe. 2021. "Using Direct Mail and Email Reminders to Reduce Choice Errors among ACA Enrollees." AEA RCT Registry. July 05. https://doi.org/10.1257/rct.6950-2.0
Sponsors & Partners
Experimental Details

Interventions

Intervention(s)
The intervention centers on Enhanced Silver-eligible members who are in Gold or Platinum plans for the 2020 enrollment year. These renewing Covered California members will receive letters and emails that encourage them to switch metal tiers (from Gold or Platinum to Enhanced Silver) so as to save on premium and out-of-pocket costs. The outreach materials include average premium savings, out-of-pocket savings and peer comparisons.
Intervention Start Date
2020-10-01
Intervention End Date
2021-02-01

Primary Outcomes

Primary Outcomes (end points)
Our primary outcome will be an indicator for whether a household enrolled in an Enhanced Silver plan for the 2021 enrollment year by the end of the Open Enrollment period.
Primary Outcomes (explanation)

Secondary Outcomes

Secondary Outcomes (end points)
A secondary outcome will be calls to Covered California's call center.
Secondary Outcomes (explanation)

Experimental Design

Experimental Design
This is a 4-arm block randomized design. The three blocks are (1) Enhanced Silver 87-eligible enrollees in Gold plans, (2) Enhanced Silver 94-eligible enrollees in Gold plans and (3) Enhanced Silver 94-eligible enrollees in Platinum plans.

Within each block, households are randomly assigned to one of 4 arms: (1) Control group that is assigned to receive no Enhanced Silver outreach, (2) Letter + 1 Email group that is assigned to receive a letter and 1 email during the Open Enrollment period, (3) Letter + 3 Email group that is assigned to receive a letter and 3 emails during the Open Enrollment period and (4) Letter + 5 Email group that is assigned to receive a letter and 5 emails.
Experimental Design Details
Randomization Method
We used Stata to carry out the randomization.
Randomization Unit
Random assignment occurs at the household-level.
Was the treatment clustered?
No

Experiment Characteristics

Sample size: planned number of clusters
N/A
Sample size: planned number of observations
20,900 households
Sample size (or number of clusters) by treatment arms
Each treatment arm includes approximately 5,200 observations.
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
To arrive at an estimate for the minimum detectable effect (MDE), we assume a baseline metal tier switch rate of 16 percent. In a pairwise comparison (e.g. Control vs. 1 Letter + 1 Email), we’d be powered at the 80% level to detect a 2 percentage point difference in Enhanced Silver enrollment rates.
Supporting Documents and Materials
IRB

Institutional Review Boards (IRBs)

IRB Name
California Health and Human Services Agency Committee for the Protection of Human Subjects
IRB Approval Date
2020-10-15
IRB Approval Number
N/A
Analysis Plan

Analysis Plan Documents

Pre-analysis plan

MD5: 8cd64ade99644bf8791b85167449fdcd

SHA1: b203beef682ec19011307fa790de82f9e40b68c5

Uploaded At: December 20, 2020

Post-Trial

Post Trial Information

Study Withdrawal

There is information in this trial unavailable to the public. Use the button below to request access.

Request Information

Intervention

Is the intervention completed?
Yes
Intervention Completion Date
February 01, 2021, 12:00 +00:00
Data Collection Complete
Yes
Data Collection Completion Date
February 01, 2021, 12:00 +00:00
Final Sample Size: Number of Clusters (Unit of Randomization)
N/A
Was attrition correlated with treatment status?
No
Final Sample Size: Total Number of Observations
19,797 households
Final Sample Size (or Number of Clusters) by Treatment Arms
4,974 treatment 1; 4,930 treatment 2; 4,954 treatment 3; 4,939 control group
Data Publication

Data Publication

Is public data available?
No

Program Files

Program Files
No
Reports, Papers & Other Materials

Relevant Paper(s)

Reports & Other Materials