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Attracting the Uninsured in the New Health Insurance Marketplace

hello my name is uninsured americanChange at a level unlike anything experienced before is underway in the health insurance industry due to the implementation of the Affordable Care Act (ACA), popularly known as Obamacare. Insurers cannot rely solely on employers to deliver large populations of employees as they may have in the past.  The Exchanges require insurers to engage consumers 1 on 1, whether they are currently among the uninsured or are transitioned to the Exchanges by employers. In order for insurance providers to remain sustainable and profitable they must also change the way they attract consumers.

To stay competitive, insurance providers must evolve beyond the statistical forecasting, pricing formulas and predictive modeling of risk, injury and disability in classic actuarial analysis. These models may break down at the individual consumer level.

New, consumer-centric strategies must pursue initiatives and branding that better attract consumers in the new Health Insurance Marketplace. While many consumers who currently have health insurance — whether through their employer or on the individual market — will end up shopping for health insurance on the Exchanges, the 30+ million uninsured consumers are wide open territory for health insurance companies. This article focuses on this population to help health insurers understand their needs.

Characteristics of the Uninsured

The c2b Consumer Diagnostic study of healthcare consumers in the United States included a sizable population of consumers who indicated they were not currently insured (n=663). It is from this population of respondents that the following statistics are derived:

  • 53% male, 47% female
  • Average age:  39.1 — versus 47.8 for insured respondents, a statistically significant difference*
  • Whites represent a higher percentage* of insured consumers than uninsured, while Hispanics/Latinos represent a higher percentage* of uninsured versus insured

uninsured consumersinsured consumers

  • Insured consumers are more likely* to be married or widowed than are uninsured consumers, while the uninsured are more likely to have never been married or divorced


  • 33% of uninsured respondents have a college or post-graduate degree, compared with 53% of insured consumers, a statistically significant difference*
  • Uninsured consumers are more likely* to have a part-time job, a student, or not be employed than are insured consumers, while the insured are more likely* to be employed full-time or retired.

 employment status

* statistically significant at 95% confidence

So the uninsured are more likely to be male, younger, single, less educated, underemployed and potentially of an ethnic persuasion, right? 

Not necessarily… nearly 2/3 are white, and 25% have an annual household income of at least $50,000.

And even if uninsured consumers neatly fit a consistent demographic and socioeconomic profile, this does not mean they all have the same needs, attitudes and motivations. Just because two people look alike does not mean they think alike.

This may seem like an obvious statement, but consumer segmentation based on demographics or socioeconomics is limited in its ability to categorize consumers according to their needs. In fact, even behavioral segmentation — that based on shopper data or medical claims data — is limited in its ability to change the behavior it measures. Two people may exhibit the same behavior, but their motivations for that behavior can be very different. Thus, the same messaging will not necessarily appeal to two consumers who look the same in a database.

Varying Attitudes Among The Uninsured

There is an appreciable portion of the uninsured population who prioritize their health and take a proactive approach toward wellness. The c2b Consumer Diagnostic asked uninsured respondents the degree to which they agreed or disagreed with the following statements; the percentages shown represent those who Agreed or Strongly Agreed:

  • I’ll spend whatever it takes to be healthy:  22% (vs. 31% insured)
  • I invest a lot of time and effort in improving my health: 31% (vs. 36% insured)
  • I am already healthy, but I take steps to be even better:  41% (vs. 46% insured)

Despite the ACA’s promise that everyone will be covered by health insurance, not all uninsured consumers support the legislation. A plurality of uninsured respondents admit they do not know whether they support or oppose the ACA; however there is actually a higher percentage of uninsured consumers who fully oppose the ACA than fully support the legislation:

 support or oppose the ACA

The c2b Consumer Diagnostic also asked respondents to rate the importance of over 30 attributes offered by health insurance companies. The top 5 rated attributes among uninsured consumers are listed in the following table.  While cost considerations rank at the top of the list, Is an Insurance Company that I Can Trust was #4 in this list of 30+ attributes. Brand equity for a health insurance company is very important to uninsured consumers, and understanding how to meet their needs and communicate with them effectively is critical to these companies’ success.

Top 5 Health Insurance Coverage/Company Attributes

Uninsured Consumers

Annual Premium is Reasonable

Co-pay is Reasonable

Offers Medical Coverage Options that Meet My Needs

Is an Insurance Company that I Can Trust

Allows Me to Get the Proper Care Regardless of Cost to Them

The c2b Consumer Diagnostic also identified five distinct psychographic segments among healthcare consumers, unique in their attitudes and motivations regarding health & wellness. Like the General Population, uninsured consumers span the spectrum of these psychographic segments, which underscores the proposition that a “one size fits all” approach will not work for all uninsured consumers:

 c2b psychographic segments

Balance Seekers and Willful Endures are over-represented among uninsured consumers, comprising 64% of this population (versus 45% of the General Population). These two segments are very different from each other in their approach to health & wellness:

  • Balance Seekers are proactive and wellness oriented; Willful Endurers are reactive to health issues and 1/3 of Willful Endurers consider themselves “couch potatoes.”
  • Balance Seekers are highly educated on health and are dedicated to nutrition and exercise; Willful Endurers are generally disengaged from their health and deprioritize wellness behaviors
  • While they seek value in healthcare transactions, Balance Seekers are willing to pay more toward monthly health insurance premiums than are Willful Endurers.

Because their motivations and behaviors are so different, these two segments respond to different messages and media. A proposition from a health insurance company may resonate strongly with Willful Endurers but turn off Balance Seekers — and vice versa. Depending on a health insurance company’s strategies and consumer target audience, the health insurance company will want to adjust its consumer engagement efforts to maximize desired consumer response.

c2b Consumer Diagnostic data can be accessed in published format or via the c2b Insights Accelerator, an interactive database that allows custom analysis of 15.6 million data points from the c2b solutions consumer research. These resources are a valuable asset to any health insurance company seeking to market itself on the Exchanges.

Image credit: mybaitshop / 123RF Stock Photo

Psychographic Segmentation and its Practical Application in Patient Engagement and Behavior Change


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