Rural Health Insurance Outreach and Enrollment

Rural healthcare facilities, public health agencies, and human service providers can help their patients, clients, and community members understand the health insurance options available under the Affordable Care Act. Providers can:

  • Conduct outreach campaigns.
  • Provide information directly to patients and clients about health coverage options in a culturally appropriate way and inform them that financial help, to pay for health insurance, is available.
  • Refer patients and clients to people and organizations who can provide in-person assistance and help them navigate the system, evaluate options, and sign up for health coverage.
  • Share the Health Insurance Marketplace website with everyone they interact with. Explain that the website is available to help people review their coverage options and sign up for coverage online, including Medicaid, Children’s Health Insurance Program (CHIP), or private insurance coverage.


Guidance on outreach and enrollment efforts is available from:

  • Enroll America, a nonprofit and non-partisan organization that works to maximize the number of Americans who enroll in health coverage.
  • The Federal Office of Rural Health Policy's ACA Team

There are more organizations related to Health Insurance Outreach and Enrollment in the organizations section.

Frequently Asked Questions

Why would rural healthcare providers want to share information with their patients regarding signing up for health insurance via the Health Insurance Marketplace?

Many healthcare professionals and facilities across the country are undertaking health insurance outreach and enrollment activities. This work falls within their mission of improving the health and well-being of their patients and may also have positive financial impact.

Benefit to the patient – Sharing information and resources with patients regarding health insurance enrollment can help patients understand options and requirements for individuals under the Affordable Care Act, increasing the likelihood that they will successfully enroll in a health insurance plan.

Having health insurance has many benefits for patients. Being insured can decrease stress and increase a person’s overall well-being through:

  • Peace of mind and reduced worry related to how to pay for needed medical care for themselves and family members.
  • Improved financial security that comes with decreased medical expenses, particularly the risk of large expenses that might result from an injury or prolonged illness.
  • Increased likelihood that individuals will seek appropriate and timely care, including preventive care, which can have positive effects on their health status, life expectancy, and general quality of life.

When many individuals in the community are impacted in these ways, population health is also improved.

Benefit to the healthcare provider/facility – Undertaking health insurance outreach and enrollment activities can have a positive effect on a rural healthcare facility. An increase in the percentage of the local population with health insurance coverage:

  • May increase the volume of primary care visits
  • May increase the likelihood of receiving payment for services provided, thereby reducing bad debt
  • May reduce the number of visits to the emergency room

In addition, conducting outreach and enrollment activities can be included in a non-profit hospital’s IRS community benefit reporting (also referred to as Schedule H or Form 990). In fact, in the Notice of Proposed Rulemaking, the IRS specifically mentions outreach and enrollment as a potential item that could be included in the implementation plan for a Community Health Needs Assessment (CHNA):

“For example, a hospital facility’s CHNA may identify as significant health needs financial or other barriers to care in the community, such as high rates of financial need or large numbers of uninsured individuals and families. Its implementation strategy could describe a program to decrease the impact of these barriers, such as by expanding its financial assistance program or helping uninsured individuals and families learn about and enroll in sources of insurance such as Medicare, Medicaid, Children’s Health Insurance Program (CHIP), and the new Health Insurance Marketplaces (also known as the Exchanges); state how it anticipates its program will reduce these barriers to care; and identify the data sources it will use to track the program’s impact on the barriers.”

What strategies can rural health and human service providers use to get key information about insurance enrollment to their patients (in-reach)?

There are several ways you can identify uninsured patients in your facility and provide them with important information regarding signing up for health insurance. These steps will help you develop a "culture of coverage" at your facility:

Be informed about coverage options

  • Equip everyone in your institution with basic information so they are able to tell patients that health insurance and financial help are available and where to go for help.
  • Consider getting staff trained in your facility as Certified Application Counselors.
  • Consider applying for your organization to be recognized as a Champion for Coverage.
  • Engage financial counselors in your institution promoting health coverage to patients.

Start a coverage conversation with patients

  • Ask patients if they need information about health coverage options.
  • If you have an intake form that asks patients if they have health insurance, consider changing the form to ask what kind of insurance they do have.
  • Gather patient income data to help identify if they are income eligible for the new health coverage options.
  • To help explain to your patients how to use their new health insurance, consider sharing Enroll America’s guide, Get Covered Guide: Understanding the New Health Insurance or the federal government’s From Coverage to Care guide.
  • Make sure that patients needing to re-enroll understand the process. 5 Steps to Staying Covered through the Marketplace explains the process.

Promote coverage options

  • Post information about the Marketplace in your office. For example, hang posters in the waiting room.
  • Incorporate information about health coverage into your voice mail.
  • Tailor on-hold messages on your organization’s phone system to promote health coverage options and the services you provide. Record these messages in the appropriate languages for your community.
  • Add the marketplace/exchange’s website link to email signatures in outgoing emails.

Help Your Patients Get the Health Coverage They Need is a guide from the American Medical Association that includes resources for physicians such as fact sheets, checklists, and resources to share with patients.

Why would rural providers share information about health insurance enrollment with their patients outside of the open enrollment period?

While most of your outreach and education efforts will probably take place during open enrollment periods, the time between those periods can be used to plan outreach initiatives that will take place shortly before or during the open enrollment period.

In addition, it can be beneficial to provide information to patients throughout the year, since:

  • You may not have the opportunity to speak to all of your patients during the open enrollment period. Providing information at other times of the year can help them understand their options when an open enrollment period comes around.
  • Some patients may qualify for special enrollment periods during the year if they experience a qualifying life event, such as a change in marital status, birth or adoption, or job loss.
  • Qualifying patients can apply for Medicaid or the Children’s Health Insurance Program at any time.

Learn more about important Health Insurance Marketplace dates.

What strategies can rural health and human service providers use to get key information about insurance enrollment out to people in their community (outreach)?

When conducting outreach and enrollment efforts in rural communities, consider where people in your community get their information, where they gather, and where they do business. Each community is different and doing this initial analysis of your community can help you identify the best strategies, locations, and partners that will help you successfully reach people in your community most in need of health coverage.

Examples of strategies and locations that might work in some rural communities include:

  • Bag inserts at the local grocery or hardware store
  • An insert in the monthly bill from a local utility company or energy assistance program
  • Announcements, bulletin inserts, or information booths at church services
  • Distribution of information by parish nurses
  • Partnering with a local library and holding informational events or posting information on their bulletin boards
  • Announcements, advertisements, or information booths at athletic events
  • Information booths at a local health fair, farmers’ market, or other community event
  • Participation in local radio programs

In its 2014 publication, Rural Implications of the Affordable Care Act Outreach, Education, and Enrollment, the National Advisory Committee on Rural Health and Human Services recommends using multiple channels to reach the rural uninsured and using “place-based” outreach where outreach and education efforts would take place in frequently visited places like libraries and barbershops. The Committee also stresses the importance of engaging rural human services agencies as outreach and enrollment entrance points.

The Best Practices Guide to Rural Outreach and Enrollment, compiled by the Federal Office of Rural Health Policy after the initial period of Open Enrollment, similarly recommends best practices in place-based outreach and effectively leveraging community resources to conduct outreach and enrollment activities in rural areas. The Guide also goes through challenges rural communities face when planning outreach and enrollment strategies and how to best overcome these challenges such as possible political resistance, limited access to internet, and geographic remoteness.

Module 11 of the 2015 document Leading Change, Best Practices in Technical Assistance for Rural and Frontier Health-Care in an Era of Transformation, discusses challenges, opportunities, and strategies for rural providers in assisting patients and community members with health coverage enrollment. The module also lists examples of how State Offices of Rural Health can help with outreach and enrollment for rural populations.

Enroll America, a non-profit and non-partisan organization that works to maximize the number of Americans who enroll in health coverage, offers guidance for facilities just starting to work on outreach and enrollment efforts:

What resources are available in my state to assist with outreach, education and enrollment?

Health Insurance Marketplaces are available to help Americans review their coverage options and sign up for coverage, including Medicaid, Children’s Health Insurance Program (CHIP), or private insurance coverage.

You can find the Health Insurance Marketplace serving your state by visiting the Get Insurance section of the website. You can also direct patients and clients to the Marketplace Call Center for assistance.

Experts in each state can also assist individuals with learning about their options and signing up for coverage. The Find Local Help section of allows you and your patients to find people and organizations in your area who can provide assistance in understanding available options and enrolling in coverage.  This may include:

  • Navigators – Navigators are available in every state to help consumers with the new application and the enrollment process. These individuals and organizations are trained, certified, and paid by the new marketplaces to provide assistance in a fair, accurate, and impartial manner. They also conduct public education activities to raise awareness about the new, affordable coverage options and provide referrals to other consumer assistance resources when appropriate. In most states, consumers can find out who in their community is participating in these enrollment assistance programs by going to their marketplace’s website.
  • Certified application counselors (CACs) – In an effort to increase the number of people who are prepared to provide in-person enrollment assistance, every health insurance marketplace is training and certifying organizations called certified application counselors (CACs) to help consumers apply for coverage. Many of these CAC organizations are already trusted sources of information for people who are uninsured. None of them will be paid by the marketplace for their work as a CAC. CACs are required to act in the best interests of applicants and to disclose any conflicts of interest to both the marketplace and to the consumers they serve. In most states, consumers will be able to find out which organizations are trained and certified as CACs by going to their marketplace’s website.
  • Government agencies – such as state Medicaid offices or Indian Health Services locations
  • Insurance agents and brokers – An agent or broker is a person or business who can help people apply for help paying for coverage and enroll in a health plan through the marketplace. They can make specific recommendations about the plans. They are licensed and regulated by states and typically get payments, or commissions, from health insurers for enrolling a consumer into an issuer's plans. Some brokers may only be able to sell plans from specific health insurers.

For a more in-depth look at the types of assistance available to consumers:

Where can I find materials to use in outreach efforts, such as brochures and posters?

The federal government and private organizations offer materials that can be replicated or used as-is in your outreach and education efforts.

Federal Resources
You can get official outreach resources to use at events, on a website, or for other outreach activities. Available resources include:

  • articles
  • brochures
  • public service announcement scripts
  • fact sheets
  • videos
  • widgets
  • graphics

Certain resources are also available in Spanish, as well as other languages.

In addition, a glossary of healthcare terms suitable for sharing with your patients or clients is available from the Center for Consumer Information and Insurance Oversight. The resource is also available in numerous languages.

Resources targeting specific audiences:


American Indians and Alaska Natives

Resources from Enroll America and Get Covered America
These organizations have developed helpful resources that can be used freely by organizations working on health insurance outreach and education:

Enroll America and Get Covered America Resources - An inventory of all resources available for outreach and education through Enroll America and Get Covered America. Includes links to maps, toolkits, factsheets, and more.

Constituency-Specific Toolkits - These resources offer suggestions to reach out to specific audiences about the new health insurance options.

How can our staff access accurate information and training about the Health Insurance Marketplaces and how to help people navigate the process of signing up for insurance?

The level of training your staff needs may vary based on the level of assistance you intend to provide. Anyone offering assistance to consumers will need access to accurate sources of information. There are many free resources available – here are some good starting points:

How can I connect to other people around the country who are doing outreach and enrollment work?

In the Loop: Connecting the Enrollment Community is a free, private online community of people working in non-profit organizations to help individuals enroll in health insurance. Register on the website to join the discussions of over 1,800 members from around the country. Members ask questions, help each other troubleshoot, and share experiences.

Members of the community include:

  • Navigators
  • In-person assisters
  • Non-profit certified application counselors
  • Community health center staff helping with enrollment and other providers
  • Non-profit health and consumer advocates
  • Staff who work at legal aid organizations
  • Staff who work at protection & advocacy organizations
  • Staff from other non-profit organizations

Where can I continue to get up-to-date and rural-specific information related to Health Insurance Outreach and Enrollment?

The Federal Office of Rural Health Policy (FORHP) shares information relevant to ACA implementation in rural communities, including health insurance outreach, education, and enrollment issues, in several ways:

  • Office Hours Calls – Regular calls support rural health stakeholders and FORHP grantees through the initial open enrollment period. Recordings of past calls can be accessed through the website.
  • Email updates – Include ACA updates and resources that are geared towards rural communities. To sign up for the list, email
  • Rural-specific contact - For any questions, issues or to share stories from the field, feel free to contact the FORHP ACA Team a