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Subsidy-Eligible but uninsured

Public HIX can balance risk pools by engaging these consumers.

Overview

Accenture research shows that 49 percent of the estimated seven million uninsured US consumers who could receive subsidies are unaware that they qualify. Younger and generally healthier than the overall public HIX population, this group of consumers represents a highly desirable cohort for both healthcare payers and public health insurance exchanges. Furthermore, since many are likely to obtain employer-sponsored coverage in the future, bringing them into the healthcare system now could help build health habits and insurer and doctor relationships that drive lifetime customer value. The key to successfully engaging these “I Don’t Knows” (IDKs) is a multi-channel, education-first approach tailored to their specific requirements around simplicity, affordability and claims coverage.

For healthcare payers and public health insurance exchanges struggling to balance risk pools, the IDKs represent a significant lost opportunity.

A more targeted, transparent and personalized approach would help engage them.

Payers and public exchanges need a deeper understanding of who they are and what matters to them.

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Video insights

The Eligible But Unenrolled Opportunity

There are a number of people who are eligible for subsidies, but are unenrolled—these consumers offer a great opportunity to help balance risk pools.

How Can Payers Interest IDKs in Enrolling in Health Insurance?

Payers and exchanges need to meet subsidy-eligible but unenrolled consumers where they are. They’re not just going to show up to a website and say, "I want this product."

Recommendations

Friends and family are trusted sources and key influencers, so digital-only outreach won’t cut it. Payers and exchanges need to reach into the offline environments where IDKs congregate and feel comfortable.

An education-first approach may also help payers and exchanges engage the IDKs and dispel their misconceptions about affordability. But because, relative to existing public HIX consumers, far fewer new public HIX consumers enrolled online, additional “live” help will also be required.

Given the income level and cost concerns of the IDKs, exchanges should analyze the eligibility process more carefully, and adjust it to avoid unintentionally confirming misconceptions about cost.

More realistic total cost-of-care estimates inclusive of cost-sharing reductions when applicable will help address the myth that health coverage is unaffordable. Simplicity and clarity will also be critical.

Payers should focus on simple, easy-to-understand plans with low out-of-pocket costs. And if routine services such as regular check-ups have no co-pay at all both healthcare payers and public health insurance exchanges should make that clear to the IDKs.

VIEW ARTICLE [PDF]

AHIP Institute

Public health insurance exchanges are in their third coverage year with three open enrollment cycles completed. In each cycle the process matures and consumer expectations and behaviors adjust. The keys to sustainability for exchanges and payers include enrolling harder-to-reach consumers, keeping consumers from dropping out and effectively assisting consumers to purchase coverage that meets their expectations.

This presentation from AHIP Institute & Expo 2016 on recent consumer research illuminates the key factors that affect consumers’ satisfaction with the process and their ability to select the most appropriate plan for themselves—including how strategies such as live assistance, digital tools, standardization and other approaches impact consumer engagement. This discussion will also feature the perspective of a public exchange executive regarding the key factors to success in the exchange market in the future.

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