Small cost increases, administrative burdens may be barriers to health coverage

Illustration: Health insurance, healthcare concept. Health insurance form, calculator, pen, glasses, money, magnifier.

January 19, 2024 – Health insurance that goes from costing zero to even a few dollars per month can keep low-income individuals from accessing coverage, according to a new study co-authored by Harvard T.H. Chan School of Public Health’s Adrianna McIntyre.

The study, published January 8 in Health Affairs, also found that it may not necessarily be the cost that’s the problem—it could be the administrative burden of having to fill out paperwork or remembering to pay a new monthly bill.

For the study, McIntyre, assistant professor of health policy and politics, and Harvard colleagues analyzed 2016 and 2017 data from the Health Connector, the Affordable Care Act marketplace in Massachusetts. They found that, among health plans that went from costing zero per month to costing $10 or less per month, enrollment dropped by 14% over the following year.

The study authors noted that most of the terminations for nonpayment occurred at the end of January, suggesting that many of those who dropped off the insurance rolls never began paying premiums when they first kicked in at the beginning of the calendar year.

In a January 10 Fierce Healthcare article, McIntyre said that “the plan terminations we observed suggested that a considerable number of enrollees whose plans took on positive premiums didn’t know that they needed to start making monthly payments, didn’t know how, or found the process so cumbersome that they ultimately never made sufficient payments to stay enrolled.”

State and federal policy changes could help keep low-income people insured, the researchers noted. For instance, McIntyre said, state policymakers could provide funds to defray small premiums.

Read the Fierce Healthcare article: Even $1 premium discourages some low-income individuals from coverage: study

Illustration: iStock/Jane_Kelly