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Shifting Open Enrollment Could Increase Participation


Bethesda, MDOn November 15, state and federal health Marketplaces will open their portals and phone lines for the 2015 open enrollment season, which runs through next February 15. While the end of the year is traditionally “open season” for health insurance, a new study being released today as a Web First by Health Affairs, recommends shifting open enrollment to the period between February 15 and April 15. The authors’ suggestion is based on insights from psychology and behavioral economics, which indicate that people make better decisions when they are not stressed by financial worries--as they often are during the end-of-year holiday season. To show the seasonality of such stress, the authors use weekly data (between January 2004 and December 2013) on US-based Google search queries related to financial security and health insurance. Their analyses show that searches relating to financial concerns were highest in the summer months and just before the Thanksgiving/Christmas holiday season. On the other hand, health insurance information searches dropped substantially between Thanksgiving and Christmas, but then rose sharply the last week of December and in early January.

Shifting The Open Enrollment Period For ACA Marketplaces Could Increase Enrollment And Improve Plan Choices

By Katherine Swartz and John A. Graves

Swartz is affiliated with the Harvard School of Public Health in Boston, Massachusetts, and Graves with Vanderbilt University’s School of Medicine in Nashville, Tennessee.

This study will also appear in the July issue of Health Affairs.

The Congressional Budget Office projects that nearly nineteen of the twenty-four million currently uninsured Americans expected to acquire health insurance through the Affordable Care Act’s insurance Marketplaces are low- and moderate-income Americans. According to Internal Revenue Service data, many lower-income Americans file their tax returns well before the April 15 deadline and are likely to receive sizeable refunds. The first months of the year are a time when these Americans, in anticipation of their tax refund, are feeling more financially secure--and, with the holiday season behind them, can focus on the complex process of selecting and enrolling in a health insurance plan. Moreover, the authors argue, between mid-February and mid-April, people likely to be eligible for the tax credit premium subsidies will have more accurate calculations of their subsidy. “Given what is known about how financial stress affects people’s bandwidth for making decisions, holding open enrollment just before or during the holiday season is a mistake,” concluded the authors. “The ACA’s goals of maximizing enrollment in the health plans and maintaining a healthy balance of enrollees with low and high risks of having high medical expenses are more likely to be achieved if the open enrollment season is shifted to the two months between February 15 and April 15 each year.”

About Health Affairs

Health Affairs is the leading journal at the intersection of health, health care, and policy. Published by Project HOPE, the peer-reviewed journal appears each month in print, with additional Web First papers published periodically at The full text of each Health Affairs Web First paper is available free of charge to all website visitors for a one-week period following posting, after which it switches to pay-per-view for nonsubscribers. Web First papers are supported in part by a grant from The Commonwealth Fund. You can also find the journal on Facebook and Twitter. Read daily perspectives on Health Affairs Blog. Download our podcasts, including monthly Narrative Matters essays, on iTunes. Tap into Health Affairs content with the new iPad app.