Evaluating the Impact of Educational Flyers Promoting $0 Deductibles and Lower Costs With Silver Plans on California Marketplace Plan Enrollment and Care Utilization
试验速览
- 阶段
- 不适用
- 状态
- 进行中（未招募）
- 入组人数
- 1,600,000
- 试验地点
- 2
- 主要终点
- Enrollment in an Enhanced CSR Plan
研究概览
简要总结
The study aims to evaluate the impact of an informational flyer insert on health plan selection and health care utilization among Covered California renewing members during the 2025 plan year. The flyer highlights the enhanced Silver plan benefits, which were expanded in 2025 to include all enrollees, regardless of income level. Key benefits include $0 deductibles, lower monthly premiums, free preventive visits, and reduced costs for primary care, emergency care, and medications.
The main questions the study seeks to answer are:
- Does the informational flyer help overcome barriers that prevent consumers from switching to more beneficial plans?
- Does the flyer encourage current Silver Plan enrollees to increase health care utilization, such as preventive visits, primary care, and medication usage, by highlighting enhanced benefits like $0 deductible and lower costs?
To address these questions, researchers will compare outcomes between households that receive the flyer insert and those that do not. Covered California's administrative data will provide individual-level information on plan selection, while claims data will offer insights into healthcare utilization patterns. This approach will help determine the effectiveness of targeted communication in driving selection of more beneficial plan and improving healthcare utilization.
详细描述
Background:
The Affordable Care Act (ACA) established health insurance marketplaces (commonly referred to as ACA marketplaces) to provide affordable insurance coverage. In addition to premium subsidies, administered through the form of advanced premium tax credits (APTCs), low-income consumers are eligible for reduced out-of-pocket costs when they enroll in a Silver plan through the ACA marketplaces. These ACA benefits, known as Cost-Sharing Reductions (CSRs), improve the plan generosity (through the form of lower copays and deductibles) while keeping premium costs at the level of a Silver plan. Traditionally, lower out-of-pocket costs are associated with higher premium payments, such as in the Platinum tier, whereas high out-of-pocket costs are paired with lower premiums, as in the Bronze tier. These CSR benefits are available for consumers who enroll in the Silver metal tier and have an income below 250 percent of the Federal Poverty Level (FPL).
California launched its own state-funded Cost-Sharing Reduction (CSR) program in 2024, increasing the benefit levels for those eligible for federally funded CSRs. These plans are referred to as "enhanced CSR plans." In the 2025 plan year, California expanded eligibility for enhanced CSR plans to all enrollees, regardless of income. This policy change improves affordability and accessibility by offering coverage comparable to Gold plans but with lower monthly premiums for all enrollees. Members already enrolled in Silver plans were automatically upgraded to the enhanced CSR plans, while those in other metal tiers (Bronze, Gold, or Platinum) had to take action to switch during the annual renewal period to benefit from these new plan designs. This study explores how additional communication in the form of an informational flyer insert about the new enhanced CSR plan benefits and their expanded eligibility may have helped overcome inertia, likely due to informational and awareness barriers, for renewing consumers.
Project Objective:
The primary objective of the study is to evaluate whether including an informational flyer insert with renewal notices affects consumer behavior in two key areas:
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Health Services Research
- 盲法
- Double (Participant, Care Provider)
入排标准
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Households who qualify for automatic renewal of their Covered California health plan as of October
- •Households that were enrolled in Covered California on the subsidized application.
排除标准
- •Households that were no longer enrolled as of January 31,
- •This includes people who chose to cancel their coverage in 2024 and those who were automatically disenrolled due to changes in eligibility during the open enrollment period.)
- •Households that were included in the affordability crosswalk
- •The affordability crosswalk is a Covered California process that moves eligible individuals with lower incomes to Silver CSR plans during renewal.
- •This population includes members with incomes below 250% of the federal poverty level who were enrolled in Bronze plans and eligible for $0 premiums with Silver plans, members below 200% of the federal poverty level who were enrolled in Gold plans, and members below 150% of the federal poverty level who were enrolled in Platinum plans.
- •Approximately 23,000 members are excluded from the experiment due to this restriction.
- •Households with members enrolled with the carrier Valley Health Plan and Dental Health Services.
- •This group was excluded due to changes in plan availability that necessitated a special notice.
- •Approximately 30,000 members are excluded from this experiment due to this restriction.
结局指标
主要结局
Enrollment in an Enhanced CSR Plan
时间窗: Up to 4 months
A binary indicator for whether a consumer enrolled in an Enhanced CSR plan in 2025 open enrollment period.
Health care utilization outcomes among individuals enrolled in enhanced CSR plans in 2025.
时间窗: 1 year
Utilization will be assessed using binary indicators for various healthcare services, including primary care visits, emergency room visits, specialist visits, hospital admissions, and pharmacy claims. For each service type, the measure will reflect the number of visits or claims per 1,000 enrollees during the 2025 plan year.
次要结局
- Consumer engagement:(Up to 4 months)
- Enrollment Tenure(1 year)
- Uninsured Status(1 year)
- Out-of-Pocket Health Care Spending(1 year)
研究者
Sulo Paudyal
Research Data Specialist
Covered California