▪ Helped individuals understand their options for coverage and get support to complete enrollment process [16–18, 22].|
▪ Offered support and resources to individuals new to health insurance, immigrants and undocumented migrants living in rural and semi-urban areas .
▪ Established trust and respect from individuals .
▪ Provide structured approach to helping individuals enroll for coverage and maintain records on the number enrollees [17, 18].
▪ Identified knowledge gap on enrollment and the ACA policy, barriers to enrollment, and technical issues .
▪ Time consuming [16–18].|
▪ Unable to provide support to everyone in need due to limited capacity [16–18].
▪ Unable to enroll individuals when technical and operations problems with enrollment system occurs [16, 17, 21, 22].
▪ Updated training to assisters can be challenging especially with ongoing changes in the ACA and other enrollment policies [17, 21, 22].
|Online decision aid||
▪ Improve individual knowledge on health insurance, plan selection.|
▪ increase individual confidence in selecting a marketplace plan .
▪ Could reduce the need for in-person assistance to enroll for a marketplace plan .
▪ Cannot determine specific aspects of an online decision aid (e.g., educational materials, cost calculator, values component) that helped individuals decide a Marketplace plan .|
▪ Only used by people living within a 90-mile radius of St Louis City .
|Community events (e.g., health fairs, 5 K-runs, school visits)||
▪ Encouraged populations to learn about health insurance coverage [16, 17].|
▪ Informed populations about resources to help with enrollment [16, 17].
▪ Helped increase private insurance enrollment in non-expanded state .
▪ Informed populations that were less likely to be informed about their coverage options under the ACA (e.g., young adults, immigrants) [17, 19, 22].
▪ Time consuming [16, 17].|
▪ Dependent on capacity and ability to organize events .
|Educational events (e.g., workshops, health sessions)||▪ Provided health insurance information and enrollment resources during health-related workshops .||▪ Time-consuming and may require multiple sessions for people to absorb the information .|
|Health Education & Promotion (HE&P)|
|Educational/ promotional materials||
▪ Simplified information on health insurance and coverage eligibility for people had a wide reach .|
▪ Informed large segment of the population about the ACA .
▪ Some people continue to struggle with the enrollment process .|
▪ Segment of the populations were not exposed to the educational materials or campaigns [16, 17].
|Social media/ online campaigns||▪ Informed people how to access educational materials and resources to enroll for coverage .|
|Advertisement campaigns (e.g., print, radio, TV ads)||
▪ Reach larger segment of the population with minimal resources [17, 24].|
▪ The public positively responded to health insurance information from TV advertisement. High volume of advertisements during open enrollment was associated with increase enrollment for coverage .
▪ Require multiple exposure for people to absorb the information .|
▪ The source of the information mattered. People can be negatively affected by certain TV ads. Negative political advertisement on the ACA was associated with declining Medicaid enrollment .
|Nudging system (paper-based or online)||
▪ Encouraged people to visit the marketplace website and review the information .|
▪ Low-cost tools (letters, emails) were just as effective than higher intensity tools to encourage individuals to enroll for coverage .
▪ The enhanced nudging system did not cause many people to switch plan .|
▪ Segment of the population (e.g., elderly) may not have access to technology and/or have limited skills to utilize it .