Health Plans: To Enroll Young People, Get the Message Right

Two of the top priorities for health insurers are finding a way to simplify the process and removing what young people see as barriers to enrollment.

In the ever-important quest for young enrollees, the primary strategy for health plans used to be awareness campaigns that simply educated them that insurance is available and why they should get it.

Now that some progress has been made there, insurers should address the other issues that keep young people from signing up, including some that aren't so obvious.

One of the first priorities should be simplifying the process and removing what young people see as barriers to enrollment, says Shelby Gonzalez, a senior health policy analyst with the Center on Budget and Policy Priorities, a Washington, DC, think tank.

"We need to present the fewest barriers possible after we've made them aware and convinced them that it is in their best interest to enroll," she says.

"You don't want them to have to get a lot of paperwork or anything that they will find tedious or complicated. The ideal is to make it a seamless enrollment process, as simple as possible for them."

One way to improve the application process is to make sure that any required documentation is obtained electronically on the back end, rather than requiring the enrollee to submit it, she says.

The transition from children's healthcare coverage to an adult plan also can be unnecessarily difficult, Gonzalez says. Few states handle that transition well, she says, leaving young people who are not savvy about insurance to figure it out for themselves.

Teach Them How to Buy a Health Plan

In some states, for instance, a 19-year-old may receive a notice that Medicaid coverage is terminating but without any accompanying information on how to obtain coverage as an adult. Many of those young people never pursue a health plan because they don't know where to start or what to do, Gonzalez says.

Twenty-eight percent of enrollees were 18-24 in the latest figures released by HHS in March 2016, which is better than the initial numbers but still not what health plans hoped for, Gonzalez says. The potential market for the individual marketplace is about 40%, she says, so that is still a significant shortfall.

Those national figures are derived from state-based risk pools, and some states are doing better than others, Gonzalez notes. California is at 38% enrollment for 18-24. That result came from an intensive outreach effort, says Sarah Lueck, also a senior policy analyst at the think tank.

Fine-tuning the Health Insurance Enrollment Message

California and other states primarily addressed young people's assumption that they don't need insurance because they're young and healthy, and they emphasized how different ACA coverage is from what they may have known in the past.

That leads into some of the finer points of enrolling, Lueck says. Successful outreach campaigns also educate young people about how expensive healthcare can be, particularly emergency care for injuries, she says. Young people may dismiss the idea of an illness hitting them, but they're more open to thinking they could be injured in an accident.

Subsidies also help get more young people in health plans, as well as making them more aware of the potential penalties for not enrolling, Lueck says.

Young people, and the uninsured population in general, are less likely to consider the potential tax implications because they may have little experience in filing income tax returns, she says. HHS is planning to emphasize this point more in its education efforts, Lueck notes.

"Just as it's hard for them to imagine getting sick and needing insurance, some people have a hard time making that calculus, looking forward to when they will file a tax return and the ramifications because they didn't have insurance," Lueck says.

"Tax liability is not on the minds of young people as much the rest of the population."