Using Personalized Letters and Emails to Increase Health Insurance Take-up in California’s ACA Marketplace

Last registered on June 22, 2021

Pre-Trial

Trial Information

General Information

Title
Using Personalized Letters and Emails to Increase Health Insurance Take-up in California’s ACA Marketplace
RCT ID
AEARCTR-0007842
Initial registration date
June 21, 2021
Last updated
June 22, 2021, 10:08 AM EDT

Locations

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Primary Investigator

Affiliation
Covered California

Other Primary Investigator(s)

PI Affiliation
Covered California

Additional Trial Information

Status
On going
Start date
2021-05-27
End date
2021-12-31
Secondary IDs
Abstract
With the passage of the American Rescue Plan (ARP) in March 2021, more consumers than ever before are now eligible for $1 per member per month (PMPM) health insurance coverage across the ACA Marketplaces. But many individuals may not be aware of the new subsidies, or of their eligibility for Cost-Sharing Reduction (CSR) Silver plans. This project's goal is to examine whether personalized letters and email reminders can increase (1) health insurance enrollment and (2) CSR Silver take-up.
External Link(s)

Registration Citation

Citation
Feher, Andrew and Emory Wolf. 2021. "Using Personalized Letters and Emails to Increase Health Insurance Take-up in California’s ACA Marketplace." AEA RCT Registry. June 22. https://doi.org/10.1257/rct.7842-1.0
Experimental Details

Interventions

Intervention(s)
In May 2021, we identified 44,000 households who submitted a Covered California application for the 2021 coverage year, were found eligible for a $1 CSR Silver 94 plan but yet to enroll. We then randomly assigned households to one of three arms: (1) a Control group assigned to receive no letter or emails during the month of June 2021, a (2) a Generic outreach group assigned to receive a letter and email reminders about the availability of $1 plans, or (3) a Personalized outreach group assigned to receive a letter and email reminders informing them that they are eligible for a $1 PMPM Enhanced Silver 94 plan.
Intervention Start Date
2021-06-07
Intervention End Date
2021-06-30

Primary Outcomes

Primary Outcomes (end points)
This randomized evaluation has three primary outcomes: (1) an indicator for whether the household selected a Covered California plan, (2) an indicator for whether the household selected a CSR Silver plan and (3) an indicator for whether the household’s plan selection has a $1 PMPM net premium. We will measure outcomes at three points in time: the end of June 2021, the end of July 2021 and the end of August 2021.
Primary Outcomes (explanation)

Secondary Outcomes

Secondary Outcomes (end points)
Secondary outcomes will include plan effectuation, duration of coverage and estimated out-of-pocket expenses.
Secondary Outcomes (explanation)

Experimental Design

Experimental Design
Households were randomly assigned to one of three arms: (1) a Control group assigned to receive no letter or emails during the month of June 2021, a (2) a Generic outreach group assigned to receive a letter and email reminders about the availability of $1 plans, or (3) a Personalized outreach group assigned to receive a letter and email reminders informing them that they are eligible for a $1 PMPM Enhanced Silver 94 plan.
Experimental Design Details
Not available
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
44,000 households
Sample size (or number of clusters) by treatment arms
11,000 were assigned to the Control group, 16,500 were assigned to the Generic treatment group and 16,500 were assigned to the Personalized treatment group.
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
The intervention will run for approximately four weeks in the month of June 2021. Given the short duration of the intervention, we expect the baseline health insurance take-up rate to be under 5 percent, based on prior evaluations among applicants referred by the Medicaid eligibility system. In a pairwise comparison (e.g. Control vs. Personalized treatment), we are powered at the 80% level to detect a 0.5 percentage point difference in health insurance take-up rates.
IRB

Institutional Review Boards (IRBs)

IRB Name
California Health and Human Services Agency: Office of Human Research Protections
IRB Approval Date
2021-05-27
IRB Approval Number
N/A
Analysis Plan

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