Suspended

Educational Flyers on Enhanced CSR Plan Enrollment and Health Care Utilization

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What is being tested

Informational Flyer Insert on Enhanced Silver Plan Benefits

Behavioral
Who is being recruted

See all eligibility criteria
How is the trial designed

Services Research Study

Interventional
Study Start: October 2024
See protocol details

Summary

Principal SponsorCovered California
Last updated: December 11, 2025
Sourced from a government-validated database.Claim as a partner
Study start date: October 4, 2024Actual date on which the first participant was enrolled.

This study is focused on understanding how providing educational flyers about enhanced health insurance plans can influence people's choices regarding their insurance coverage in California. With recent changes making enhanced Cost-Sharing Reduction (CSR) plans available to all enrollees, regardless of income, the study aims to see if these flyers help people switch to more affordable and generous plans. The flyers inform consumers about the benefits of these enhanced CSR plans, such as $0 deductibles, lower monthly premiums, and reduced costs for medical visits and medications. The research targets low-income individuals who qualify for Silver plans under the Affordable Care Act (ACA) and seeks to explore whether better communication can help these individuals access improved health coverage. Participants in the study will receive informational flyers alongside their renewal notices to see if this additional information prompts them to switch to the enhanced CSR plans or utilize more healthcare services. The study will evaluate two main outcomes: whether people enrolled in other insurance tiers decide to switch to the enhanced CSR plans upon learning about the benefits, and whether individuals already in Silver plans increase their healthcare use after becoming eligible for the enhanced benefits. By assessing these outcomes, the study hopes to determine the effectiveness of targeted informational strategies in improving health plan enrollment and utilization.

Official TitleEvaluating the Impact of Educational Flyers Promoting $0 Deductibles and Lower Costs With Silver Plans on California Marketplace Plan Enrollment and Care Utilization 
NCT07136233
Principal SponsorCovered California
Last updated: December 11, 2025
Sourced from a government-validated database.Claim as a partner

Protocol

This section provides details of the study plan, including how the study is designed and what the study is measuring.
Design Details
1600000 patients to be enrolledTotal number of participants that the clinical trial aims to recruit.
Services Research Study
These studies look at how healthcare is delivered, managed, and organized. They aim to improve care quality, patient experience, and access to treatment.

How participants are assigned to different groups/arms
In this clinical study, participants are placed into groups randomly, like flipping a coin. This ensures that the study is fair and unbiased, making the results more reliable. By assigning participants by chance, researchers can better compare treatments without external influences.

Other Ways to Assign Participants
Non-randomized allocation: Participants are assigned based on specific factors, such as their medical condition or a doctor's decision.
None (Single-arm trial): If the study has only one group, all participants receive the same treatment, and no allocation is needed.

How treatments are given to participants
Participants are divided into different groups, each receiving a specific treatment at the same time. This helps researchers compare how well different treatments work against each other.

Other Ways to Assign Treatments
Single-group assignment: Everyone gets the same treatment.
Cross-over assignment: Participants switch between treatments during the study.
Factorial assignment: Participants receive different combinations of treatments.
Sequential assignment: Participants receive treatments one after another in a specific order, possibly based on individual responses.
Other assignment: Treatment assignment does not follow a standard or predefined design.

How the effectiveness of the treatment is controlled
In a non placebo-controlled study, no participants receive an inert substance (placebo) to compare outcomes. Instead, all participants receive either the experimental treatment or an alternative treatment (often the Standard of Care). This method allows researchers to compare the effects of the experimental treatment with those of a different active intervention, rather than a placebo.

Other Options
Placebo-Controlled: A placebo is used to compare the effects of the experimental treatment with those of an inert substance, isolating the true treatment effect.

How the interventions assigned to participants is kept confidential
Neither participants nor researchers know who is receiving which treatment. This is the most rigorous way to reduce bias, ensuring that expectations do not influence the results.

Other Ways to Mask Information
Open-label: Everyone knows which treatment is being given.
Single-blind: Participants do not know which treatment they are receiving, but researchers do.
Triple-blind: Participants, researchers, and outcome assessors do not know which treatment is given.
Quadruple-blind: Participants, researchers, outcome assessors, and care providers all do not know which treatment is given.

Eligibility

Researchers look for people who fit a certain description, called eligibility criteria: person's general health condition or prior treatments.
Criteria
Any sexBiological sex of participants that are eligible to enroll.
Healthy volunteers allowedIf individuals who are healthy and do not have the condition being studied can participate.
Criteria

Inclusion Criteria: * Households who qualify for automatic renewal of their Covered California health plan as of October 4. * Households that were enrolled in Covered California on the subsidized application. Exclusion Criteria: Households that were no longer enrolled as of January 31, 2025. This includes people who chose to cancel their coverage in 2024 and those who were automatically disenrolled due to changes in eligibility during the open enrollment period.) * Households that were included in the affordability crosswalk 1. The affordability crosswalk is a Covered California process that moves eligible individuals with lower incomes to Silver CSR plans during renewal. 2. This population includes members with incomes below 250% of the federal poverty level who were enrolled in Bronze plans and eligible for $0 premiums with Silver plans, members below 200% of the federal poverty level who were enrolled in Gold plans, and members below 150% of the federal poverty level who were enrolled in Platinum plans. 3. Approximately 23,000 members are excluded from the experiment due to this restriction. * Households with members enrolled with the carrier Valley Health Plan and Dental Health Services. 1. This group was excluded due to changes in plan availability that necessitated a special notice. 2. Approximately 30,000 members are excluded from this experiment due to this restriction.

Study Plan

Find out more about all the medication administered in this study, their detailed description and what they involve.
Treatment Groups
Study Objectives
One single intervention group 

is designated in this study

This study does not include a placebo group 

Treatment Groups
Group I
Experimental
Renewing Covered California members who receive the informational flyer insert during the 2025 plan year along with a standard renewal notice informing them of their upcoming coverage renewal and encourages consumers to shop for coverage ahead of the next coverage year.

Alongside the standard eligibility notice informing participants about their upcoming coverage renewal, an informational flyer is also included. The flyer explains that everyone is eligible in 2025 for the Silver plan regardless of income and highlights its benefits, such as $0 deductibles, lower monthly premiums, free preventive visits, and reduced costs for primary care, emergency care, and medications.
Study Objectives
Primary Objectives

A binary indicator for whether a consumer enrolled in an Enhanced CSR plan in 2025 open enrollment period.

Utilization will be assessed using binary indicators for various healthcare services, including primary care visits, emergency room visits, specialist visits, hospital admissions, and pharmacy claims. For each service type, the measure will reflect the number of visits or claims per 1,000 enrollees during the 2025 plan year.
Secondary Objectives

A binary indicator for consumers engagement including calls to service center, logins to user account, plan shopping on the website

Measured as the total dollar amount spent by enrollees on out-of-pocket health care costs, including copayments, coinsurance, and deductibles, during the 2025 plan year.

Measured as the total duration of continuous enrollment in a health plan during the 2025 plan year, expressed in months. This outcome will assess whether receiving the educational flyer impacts the length of time enrollees remain covered.

A binary indicator identifying whether an individual has any uninsured months during the 2025 plan year, as determined by Franchise Tax Board (FTB) data.

Study Centers

These are the hospitals, clinics, or research facilities where the trial is being conducted. You can find the location closest to you and its status.
This study has 1 location
Suspended
Covered CaliforniaSacramento, United StatesSee the location
SuspendedOne Study Center