Factors Affecting Health Insurance Enrollment Through the State Marketplaces: Observations on the ACA’s Third Open Enrollment Period

By Justin Giovannelli and Emily Curran

Nearly 12.7 million individuals signed up for coverage in the Affordable Care Act’s (ACA) health insurance marketplaces during the third open enrollment period, and by the end of March there were 11.1 million consumers with active coverage. To maintain membership and attract new consumers, the state-based marketplaces must sponsor enrollment assistance programs and conduct consumer outreach. These marketplaces relied heavily on such efforts during the third enrollment period, despite declining funding.

Studies of marketplace policies and enrollment assistance practices during the first and second open enrollment periods have identified a number of factors that likely influence enrollment. We sought to build on these analyses by examining the actions taken by state-based marketplaces to maximize enrollment and consumer assistance during the most recent open enrollment season. To do so, we asked marketplace officials to complete a confidential questionnaire that sought to identify what assistance and outreach strategies they viewed as most effective and what factors they identified as exerting important influence on sign-ups, positively and negatively.

To learn what strategies states employed, check out our latest publication for The Commonwealth Fund, including a summary of state-based marketplace enrollment and state insights on perceived enrollment barriers and affordability concerns.

You can access it here.

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