4 ways to attract young invincibles

Young invincibles are a vital ingredient to the long-term survival of the exchange plans under the Affordable Care Act (ACA). But the term “young invincibles”-used to describe 18 to 34 year olds-also pinpoints an attitude that insurers must try to override: I don’t need insurance, so why buy it?

According to 2010 Census data, there are 73.7 million people ages 18 to 34 in the United States. Out of the 45 million uninsured nationwide, young adults make up the largest portion at about 19 million.

Nearly a quarter of the 2.2 million people who have enrolled in health coverage through the federal and state exchanges so far are young adults, according to a January report by the Department of Health and Human Services (HHS). That’s below the 38% estimate the Obama administration has given for ensuring that premiums stay low.

The Congressional Budget Office estimates that 7 million people will sign up during open enrollment, including about 2.7 million young adults. While administration officials say they are satisfied with current numbers, they hope to increase young adult enrollment before the March 31 deadline.

Millions of young adults have already gained coverage through the ACA’s provision allowing family-plan dependence until age 26, and there is still a potential market of 18 to 34 year olds for the exchanges. Kentucky and Washington estimated that more than one-third of early enrollments in their respective exchanges were within the 18-to-34 age group.

Using Massachusetts’ health reform as an example, older and sicker people signed up first, while others primarily waited until the end of the six-month enrollment period. ACA enrollment is following in a similar pattern, which allows plans a last-minute opportunity to catch the attention of the younger demographic, according to experts.

Before open enrollment comes to an end, acquire a well-balanced risk pool and ensure your plan’s sustainability by attracting young invincibles with these best practices.

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1/ PRIORITIZE MEMBER ENGAGEMENT

A start-up health plan co-founded by three technology entrepreneurs has been sparking a lot of interest in New York. The three friends behind Oscar Health plan are looking to compete in the marketplace. With its market niche, the industry has dubbed it the plan for young people, the founders say.

“We designed a new kind of health insurance that is simple, guides members through a complex healthcare system, and makes them feel like they have a doctor in the family,” says co-founder Mario Schlosser. “We are observing that the simplicity and utility of our product speaks for itself.”

Oscar prioritizes member engagement by offering an interactive experience that focuses on ease of use. The plan also offers value-added services, such as free 24/7 telemedicine through a partnership with Teledoc with the ability to have a physician on the phone within an hour of a member’s request. Most importantly, the plan is reinventing the typical healthcare process by having the member seek out the health plan prior to the visit.

Oscar also provides free generic drugs, one-click refills through a Twitter-like interface, online rate comparisons and other web-based tools, such as an interactive map of in-network providers.

“Everyone deserves member-friendly health insurance,” says Schlosser. “Our product is useful and affordable so that everyone, no matter what age or background, will want to sign up.”

The co-founders have compared their product to Google in the way that customers can search the site and get an answer.

“Plans should speak their members’ language and offer products that operate like the rest of the Internet and the most consumer-friendly applications and gadgets out there,” he says. “The best marketing strategy won’t be able to gloss over poor usability, counter-intuitive processes and other product failures.”

Young adults make up 24% of current Obamacare enrollees  >

2/ MICRO-TARGET DIFFERENT POPULATION SEGMENTS

Just because young people share commonalities, experts say that it’s a mistake to approach all 18 to 34 year olds the same way. It’s important to develop a refined strategy that micro-targets the subsegments of the young adult population, such as ethnic groups. This is something that the Covered California exchange has done well, according to Aaron Smith, co-founder and executive director of Young Invincibles, a national nonprofit advocating for the voice of young adults on issues like healthcare.

“Whether it’s young Latinos or young African Americans, young professionals or young students, these are all slightly different demographics that have slightly different economic interests and health needs,” he says.

Young Invincibles recently teamed up with Univision on a mobile app to reach a young Latino audience. It also has a partnership with a hip-hop radio station in Los Angeles, which has integrated healthcare advertisements into all of its concerts.

One mistake for insurers to avoid is assuming that all young people are going to pick the same type of health plan: a high deductible, low premium plan. Young people are attracted to all different levels of plans, Smith says, and many who have enrolled with the help of Young Invincibles have opted for more robust, comprehensive coverage.

According to HHS, the majority of enrollees overall have purchased Silver plans (60%) as opposed to Bronze (20%), Gold (13%) and Platinum (7%). Purchase preferences for 18 to 34 year olds have not been released.

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3/ THINK OUTSIDE THE BOX

It helps to get creative when reaching out to young people, especially on social media.

“A lot of people think [ACA] is very complicated. And there is a certain complexity, but the main thing is breaking down the barriers so that people realize they can sign up and there’s coverage out there,” says Ted Goldman, veteran legal affairs writer and editor in Washington, D.C., and lead author of a recent Health Policy brief on young adults and the ACA.

YouTube videos are a great place to start. Rocky Mountain Health Plan created an entire site dedicated to a leaked “zombie apocalypse” video that urges people to sign up for coverage before it’s too late. The video has received more than 44,000 views.

“Tell a Friend-Get Covered,” a national campaign led by Covered California in collaboration with other state exchanges and Enroll America, has been using an online social presence to raise awareness about health reform among young people. The campaign actively uses the Obama administration’s hashtag #GetCovered with all of their media.

In January, the campaign hosted a six-hour live YouTube event, which aimed to inform young people about how to obtain coverage. Featuring policy makers and celebrities, the event also promoted wellness.

In partnership with the campaign, a number of videos geared toward young adults that feature celebrities have been released by Whitehouse.gov as well as Funny or Die, a popular comedy video website. In contrast to these efforts, the organization Generation Opportunity is taking its “Creepy Uncle Sam” ad campaigns to platforms like YouTube and SnapChat, a popular photo messaging application, to encourage young adults to opt-out of coverage. Views on YouTube for the ad have reached more than 2 million.

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4/ PROVE WHY COVERAGE IS FINANCIALLY SOUND

A survey by the Kaiser Family Foundation found that 52% of young adults cited cost as their primary reason for not having coverage as opposed to not needing coverage (17%).

Although the initial mentality might be to simply sell a product, plans should prioritize explaining to young people why purchasing coverage is a good financial decision.

“It’s not about selling young people on some idea or slick marketing campaign,” Smith says. “For many, health insurance has been a tough financial decision because they don’t make very much money, they have jobs that don’t provide benefits and there’s skepticism about whether the product is going to be affordable and whether it’s going to cover them when they need it. But young people are pretty hungry for unbiased, just-the-facts information.”

According to a December, 2013 Health Affairspolicy brief, young adults are two to four times more likely to forgo treatment for medical problems.

Young people also go to the emergency room more than any other age group and 15% have chronic conditions, according to Smith. He says polls have shown that young adults want health insurance, they just haven’t been able to afford it. The idea of paying a penalty and getting nothing for it verses purchasing coverage and receiving services in return is an important message to convey.

“You get health insurance for more reasons than just to avoid a catastrophic crisis,” says Goldman. “If you end up with a high deductible plan, you’re still going to pay a negotiated rate even if you have to pay out of pocket. If you get an MRI, it’ll be $500 or $600 instead of $1,500 or $2,000, which is what you’d get if you walked in off the street without coverage. It may be a bit archaic, but it’s pretty important.”

Young Invincibles estimates that some 9 million young adults with incomes 133% to 400% of the Federal Poverty Level will be eligible for a premium tax credit that will reduce or eliminate the price paid for coverage through the exchanges, but many aren’t even aware. A survey by PerryUndem showed that 69% of uninsured adult respondents did not realize financial help was available through the exchanges.

Nonprofit advocacy groups and some health insurers are working hard to get the word out and are pointing to helpful tools, such as subsidy calculators. Another useful tool is Blue Cross Blue Shield of Michigan’s Text 4 Subsidy resource, which allows consumers to initiate a back and forth exchange detailing their subsidy eligibility. The text-messaging-based tool is available to most young people daily. 

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Julia Brown is MANAGED HEALTHCARE EXECUTIVE'S Content Specialist.