Responding to COVID-19: State-Based Marketplaces Take Action

Julie Bataille, Alison Kruzel, and Caitlin Hodes, GMMB

As the COVID-19 crisis began to take hold, state-based marketplaces (SBMs) were quick to respond to the first nationwide public health emergency since the Affordable Care Act created new coverage options in states. Marketplaces used their decision-making flexibility to trigger new special enrollment periods (SEP), as part of states’ responses to the pandemic and to answer an increased demand for health insurance and care. In conversations with seven SBMs that established an SEP—Colorado, Maryland, Massachusetts, Nevada, New York, Rhode Island and Washington—we uncovered strategies that successfully drove enrollment, including: leveraging their SBM status to quickly and efficiently operationalize customer service in a new remote environment, directly engaging with existing customers as well as reaching out broadly to new ones, and adapting outreach tactics based on new insights regarding audience needs and behaviors to reach them most effectively.

Decision to Establish COVID-19 SEP Rooted in Public Health Goals

Each year during open enrollment, SBMs implement innovative strategies to enroll as many residents as possible in coverage and to lower uninsured rates in their state.

As COVID-19 took hold, SBMs and state leaders across the country recognized that if people did not have health coverage, they would be less likely to seek treatment and care for the virus, resulting in unnecessary complications and even deaths. And from a broader public health perspective, marketplaces recognized that having a larger uninsured population could ultimately result in the virus spreading more widely across the population. States quickly reached the decision to implement an SEP that would allow any uninsured residents in their state to enroll in a health plan during the public health emergency. And as the economic impacts of the crisis became clear, this audience grew to those needing marketplace or Medicaid coverage—many for the first time—as more residents lost jobs and their employer-sponsored insurance.

Ability to Quickly Implement the SEP

States worked to quickly operationalize COVID-19 SEPs through mechanisms afforded by their SBM status. This entailed not only updating application portals and website pages, but also transitioning to virtual in-person enrollment assistance and remote call center staffing. Additionally, states extended SEP deadlines and updated materials as the environment changed and predictions of the long-term economic consequences of the pandemic became more severe.

• Washington: As the state began rolling out and promoting its SEP, the marketplace was intentional about proactively communicating with its assister network as it transitioned from the in-person model to operating virtually. In addition, the SBM worked with community organizations within the assister network who offered to help customers over the phone via their own hotlines and drive call volume away from the call center which had been experiencing extremely high volume.
• New York: Following the COVID-19 public health emergency declaration in New York, NY State of Health, together with the New York State Department of Financial Services, announced a Special Enrollment Period on March 16 for eligible individuals to enroll in health insurance through the marketplace or directly through insurers. NY State of Health was able to quickly launch an education and awareness campaign to reach New Yorkers at risk of losing job-based health insurance due to COVID-19 to promote the marketplace as a source to find and enroll in affordable, comprehensive coverage.

Meeting Needs of New and Existing Customers  

Raising Brand Awareness with New Audiences

Though SBMs have become established destinations for consumers to find quality, affordable coverage, the economic impacts of the COVID-19 pandemic mean that marketplaces are now reaching out to new audiences as they raise awareness of health coverage options for consumers. At the same time, they are also making sure existing customers are in the right plan and getting the right financial help to make coverage as accessible as possible. 

Messaging to Raise Awareness of Coverage Options and Drive Enrollment

Most states have responded by promoting this SEP to uninsured groups, similar to how they would promote open enrollment: underscoring that marketplaces are open for business and here to help, and promoting financial help and free enrollment assistance. There has been an increasing shift towards promoting coverage to individuals who lost their employer-sponsored insurance, as the economic crisis has further taken hold and as some COVID-specific SEPs have expired.

• Nevada: While originally promoting loss of job-based coverage and COVID-19 SEPs separately, the marketplace shifted to encourage those who missed open enrollment in 2019 to use this opportunity to get coverage and the peace of mind that comes with it. (Example)
• Massachusetts: The state is broadly encouraging residents, including those who have lost their job-based coverage, to check out their coverage options through the Health Connector’s updated webpage. Being able to establish a broad COVID-19 SEP has allowed them to avoid messaging the nuances of enrolling within 60 days of losing your job-based coverage to minimize confusion for consumers. (Example)

Leveraging Direct Consumer Touchpoints with Existing Customers

Beyond the uninsured, current marketplace customers are also facing impacts of COVID-19. Marketplaces are leveraging the trust they’ve built with existing customers to share information about how to update job or income changes, how to consider stimulus checks and unemployment payments when applying for a tax credit, and how those changes could impact eligibility for financial help.

• Massachusetts: Communication with existing members has included proactive social media promotion and emails focused on how and why to report income changes, and clarifying that stimulus payments don’t need to be reported. The marketplace also conducted robocalls to existing customers to share this information.
• Rhode Island: The state sent text messages in English and Spanish to existing customers encouraging them to report changes, and sent targeted emails to anyone who had previously explored health insurance but never enrolled.

Scaling Integrated Marketing and Outreach Campaigns

Ramping up Earned and Social Media Efforts

Promotion often kicked off with heavy earned and social media outreach, highlighting SEPs and targeting messaging towards uninsured individuals and those who lost their job-based coverage. These tactics helped fill gaps in spreading the word that would normally be done through in-person outreach and enrollment events. They also tapped into changing media behaviors, as more consumers were turning to local news for information about COVID-19 and spending more time online while staying home. States have taken to live streaming, Twitter chats, and strategic email and SMS marketing to promote the SEP and engage with consumers on social platforms, responding to their questions in real time. The media has also responded with an eagerness to push out enrollment information, with some marketplaces reporting a level of media coverage closer to what they see during the annual open enrollment period. Websites have also been updated and re-developed to house information for consumers in different languages.

• Nevada: The marketplace hosted several Facebook live streams and Twitter chats where staff could respond to questions and engage with key partners and consumers. The SBM has seen good response and engagement, and has been able to pinpoint where consumers are confused and respond in real time.
• Colorado: The state aggressively pushed out press releases and promoted the marketplace as a resource to media, resulting in 236 media mentions during the SEP compared to 184 mentions during the total span of open enrollment—not only in the Denver metro area, but also in smaller newspapers that reach key target audiences.

Increasing Agency Coordination and Organizational Partnerships

As states took control of the COVID-19 response overall, there was an increased focus on agencies working together to best meet residents’ needs, including promoting health coverage options. Health agencies are working with Departments of Labor, Insurance, and Human Services, among others, to utilize consumer touchpoints and channels to provide resources and information about health coverage, eligibility and enrollment.    

• Rhode Island: Public information officers andcommunications directors across all state agencies hold a daily morning call to share updates during the state of emergency and make requests for content to be included in the Governor’s daily press briefings. The marketplace is also working to include a mailer in Department of Labor and Training communications with constituents.
• Massachusetts: As the state has seen a deluge of people filing for unemployment, the marketplace is coordinating closely with the state’s unemployment agency to include information about available health insurance options as people seek unemployment benefits. As a result of these efforts, a link to the Health Connector’s website is included on the final page of the state’s online unemployment application.
• New York: NY State of Health and the New York State Education Department are working together to reach families who may have lost health coverage during this pandemic, by getting information out to school leaders to then share with families within their districts.

In addition, many states are tapping key partners that are often engaged during the open enrollment period, leveraging virtual opportunities to share coverage information with consumers and business owners. Marketplaces are working with insurance carriers, chambers of commerce, professional associations, school districts, libraries, community organizations, and others to help get the word out.

• New York: While the spring is usually filled with many in-person outreach events, the Marketplace focused on existing partners who could help spread the word about coverage options. This included airing PSAs about available coverage options in 88 grocery stores across the state, as well as in more than 400 CVS Pharmacy locations. The marketplace is also coordinating closely with more than 190 colleges to distribute a toolkit to Health Directors to share with students who are studying remotely. In addition, the Marketplace connected with a longstanding partner, Grow NYC, to get educational materials out to dozens of farmers markets to share with their customers.  It is also working with food pantries to distribute NY State of Health rack cards through mobile food pantries, pickups, deliveries, and drive-thru events across the state. 

Investing in Digital Advertising

Some states reallocated budget that would traditionally go towards events and in-person outreach, moving to more investments in digital media. In some cases, they used additional emergency resources to amplify paid buys. As residents began to consume more content across digital platforms, states have been closely watching and re-allocating their paid media dollars to match this shift. All states shifted to be heavier on digital and lighter on traditional TV, and in some cases eliminated traditional radio and moved to streaming services due to decreases in “drive time” as most people were not commuting to work.

• Colorado: Instead of implementing a statewide digital ad campaign, the marketplace opted to have a heavier presence in the Denver metro area as well as in mountain communities where COVID-19 outbreaks and job loss implications were taking hold.
• New York: As part of its advertising awareness campaign, NY State of Health prioritized paid advertising statewide to reach many New Yorker’s who are at risk of losing their health insurance as a result of COVID-19. Advertising was targeted to the following industries most at risk of losing their health coverage due to business closures or the in-person nature of the work: accommodation/food services, arts, entertainment and recreation, taxi/Uber, childcare, barber shops/hair salons/nail salons, home health care, and some retail). Ads are running statewide on television, digital (through social, search and display) and radio and are in English, Spanish, and Mandarin.

Enrollment Results Demonstrate Urgent Demand for Coverage

SBMs have seen high demand for marketplace and Medicaid coverage during this crisis. For example, Maryland Health Connection has enrolled nearly 29,000 individuals to date—a 70% increase from last year’s SEP enrollments. More than 19,000 individuals enrolled through Washington Healthplanfinder and more than 14,000 individuals enrolled through Connect for Health Colorado during each state’s SEP.

States are also taking a closer look at who enrolled during SEPs and, in some cases, are making gains with populations that have been historically underinsured or uninsured. For example, of the 29,000 Maryland enrollees, nearly 35% were young adults.

Looking Ahead: Addressing Inequities and Other Issues

COVID-19 has brought about an increased demand for qualify, affordable health insurance. It has also highlighted the existing inequities in our health care system across race, income and other demographics. Moving into the 2021 open enrollment period, there will be ongoing issues to address, including improving access to coverage and care for those most impacted by COVID-19; dealing with churn across public and private programs as eligibility rules and income levels change; and monitoring fluctuating job situations and resulting need for coverage. States will need to consider how the pandemic will impact plan renewals and attitudes towards health insurance, and how shifting marketing and outreach strategies may help address the health inequities they have been confronting for years and have seen elevated as a result of COVID-19.