Nov, 13, 2025

Uncovering the Why: Surveying Consumers Who Don’t Maintain Marketplace Coverage 

Elizabeth Lukanen, SHADAC and Melissa Morales, GMMB 

Changes ushered in by recent federal policy actions, including H.R.1, the 2025 Marketplace Integrity and Affordability Rule, and the pending expiration of the enhanced premium tax credits (ePTCs), will raise premiums, increase administrative burdens, and may ultimately lead consumers to forgo health insurance coverage. To document the impacts of federal policy changes and communicate them effectively, State-Based Marketplaces (SBMs) should prioritize the regular reporting of monitoring metrics. While much of this monitoring can be done using metrics that are already collected by SBMs for internal operations or federal reporting, SBMs may want to consider special data collection to capture the reasons that consumers are not maintaining or signing up for coverage. 

Targeted surveys can be a relatively quick and inexpensive way for SBMs to better understand why consumers are not reenrolling in coverage. A short, one-question digital survey could be used to reach individuals who were previously enrolled in a qualified health plan but chose not to reenroll. Below are sample survey questions that could be sent either during or after open enrollment to gather more information, including an example from the Maryland Health Benefit Exchange, along with general guidance on question language, timing, and more. 

Surveying Consumers During Open Enrollment 

SBMs can send consumer surveys during open enrollment, both to collect early insights into consumer sentiment, and also to serve as a final nudge for consumers who may still be shopping but have not completed the enrollment process. It is important that the wording of survey questions sent during open enrollment be crafted carefully to make it clear that consumers can still sign up for coverage if they are still shopping or have not yet but plan to enroll. 

Sample Question – Consumers Who Haven’t Completed the Enrollment Process 

Which of the following best describes why you haven’t reenrolled in a health plan for 2026? Choose only one. 

  • I am still exploring my health plan options.  
  • I am eligible for Medicare or Medicaid.  
  • I have access to health coverage through an employer or spouse.  
  • The cost is too high. 
  • I can’t find a plan that has my doctor or healthcare provider.  
  • The experience of shopping for health insurance through [Marketplace] is too confusing or difficult. 
  • I moved out of state. 
  • I do not want health insurance. 
  • Other. 

 

Sample Question – Consumers Who Elected to Stop or Cancel Their Current Plan 

Which of the following best describes why you decided to end or cancel your current health plan? Choose only one. 

  • I am shopping for a different health plan option.  
  • I enrolled in Medicare or Medicaid.  
  • I got health coverage through my employer or spouse. 
  • The cost is too high. 
  • My plan no longer covered my doctor or healthcare provider. 
  • I was dissatisfied with my experience enrolling and shopping for insurance on [Marketplace]. 
  • I moved out of state. 
  • I do not want health insurance. 
  • Other. 

State Spotlight: Maryland Health Benefit Exchange 

The Maryland Health Benefit Exchange (MHBE) surveys their consumers within the application platform when an individual selects to cancel coverage. MHBE uses the information gathered from this coverage termination survey question in a monthly report to inform leadership. To encourage consumers to respond, question and response options are concise (Figure 1).  

Figure 1. Maryland Health Benefit Exchange Termination of Coverage Survey Question  

Behavioral Nudges and Offering Assistance  

For surveys sent during open enrollment, consider adding language reminding people that they can still take action until January 15 (or the state’s enrollment deadline). Also consider directing consumers to customer service resources, such as the Marketplace’s call center or local assisters, and alert service teams in advance of when surveys are distributed. 

Sample wording: 

  • Nudge: It’s not too late to sign up for a 2026 health plan. Enroll by [INSERT STATE DEADLINE] for coverage starting January 1, 2026. [IF SENDING IN LATE-DECEMBER/JANUARY]: Open enrollment ends January [INSERT STATE DEADLINE]. 
  • Customer service resource: Free assistance is available. We’re here to help you find a plan that works for your budget. Visit [URL] or call [XXX-XXX-XXXX] to speak with a trained expert. 
  • SBMs with outbound call capability: Would you like to receive a call from  [Marketplace]/have a Navigator reach out to set up a free appointment to walk you through your options?  

Surveying Consumers After Open Enrollment 

Once open enrollment is complete, SBMs could consider surveying consumers who didn’t maintain coverage. These types of surveys should be sent to consumers after they can no longer take action to enroll in a Marketplace plan, but no more than a week or two after the close of open enrollment, when experiences are still fresh.1    

Sample Question – Consumers Who Didn’t Maintain Coverage 

What is the primary reason you chose not to reenroll in a health plan for 2026? Choose only one.  

  • I enrolled in Medicare or Medicaid.  
  • I got health coverage through my employer or spouse.  
  • The cost was too high. 
  • I ran out of time and couldn’t complete the process before the open enrollment period ended. 
  • I couldn’t find a plan that had my doctor or healthcare provider.  
  • I was dissatisfied with my experience enrolling and shopping for insurance on [Marketplace]. 
  • I moved out of state. 
  • I do not want health insurance. 
  • Other. 

Conclusion 

Given the scope of recent federal policy changes, SBMs have a compelling interest in understanding how these changes may be influencing consumer enrollment decisions. Targeted consumer surveys can offer a relatively quick and low-resource method for states to gather insights.  

While this information can be valuable, it’s important to recognize the limitations in its generalizability. Because these surveys rely on convenience samples, they are likely to have low response rates and may not be representative of the broader target population. Care should be taken when interpreting and presenting the results.  

If your SBM would like assistance in developing a survey, please contact us here.  

  1. States should segment their data and not survey consumers with Deferred Action for Childhood Arrivals (DACA) status who had coverage in 2025, as they are no longer eligible for coverage under the 2025 Marketplace Integrity and Affordability Rule.