CMS - Philadelphia Announcements (Healthcare.gov Open Enrollment Happening Now! Medicare - Medicaid - C2C - Do More. Risk Less & Focus on Nursing Home Staffing)
Posted 24 days ago by Elaine Crain
Hi Maryland and Washington D.C. Partners,
I hope you all are well. First and foremost, we extend our heartfelt gratitude for your dedication in supporting community members in accessing health insurance and health wellness resources. This email provides some of the Centers for Medicare & Medicaid Services’ (CMS) program updates related to Medicare, Medicaid/Children’s Health Insurance Program renewals and the Health Insurance Marketplace Open Enrollment Period. You’ll find below CMS’ Coverage to Care (C2C) initiative that explains how to obtain care after securing health insurance coverage. Also included are information about how to prevent the flu virus, the “Risk Less. Do More” respiratory virus prevention campaign, the investment in health centers to provide care for those reentering the community after incarceration, and lastly, the nursing home staffing campaign.
As our trusted partners, we are asking for your help in aligning these key messages and resources with the needs of those you serve.
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HEALTH INSURANCE MARKETPLACE 2025 Open Enrollment Period Report: Third National Snapshot
Apply Now at Healthcare.gov or by calling 1-800-318-2596
Today, the Centers for Medicare & Medicaid Services (CMS) released the Marketplace 2025 Open Enrollment Period Report: Third National Snapshot. CMS is committed to creating a robust Marketplace Open Enrollment process for consumers so they can effortlessly purchase high-quality, affordable health care coverage. CMS reports that a record 16.6 million consumers signed up for plan year 2025 and will receive up to a full year of coverage beginning January 1. Of those consumers, 2 million are new to the Marketplace this year. This represents selections in the 31 states that use HealthCare.gov. Plan selection continues in most State-based Marketplaces, as well. The next national snapshot will be available in early January.
Marketplace Open Enrollment on HealthCare.gov runs from November 1 to January 15. Most consumers who enroll between now and January 15 will get coverage starting February 1, 2025.
A press release for today’s announcement is available at: https://www.cms.gov/newsroom/press-releases/healthcaregov-breaks-new-record-166-million-consumers-signing-up-coverage-highest-ever-january-1.
Upcoming Weeks of Action:
Week of December 29th:
Health and Wellness Week of Action (Social Media Toolkit and Graphics)
Week of January 5th:
Gig Workers Week of Action (Gig Workers Week of Action (PDF))
Young Adult (18-34) Week of Action (Young Adult (18-34) Week of Action (PDF))
MEDICARE
Medicare Special Enrollment Period
Inflation Reduction Act (new drug law) Social Media Toolkit
- The toolkit includes the following resources:
- A document that describes the toolkit and how it can be utilized
- Medicare Extra Help graphics
- Medicare Insulin graphics
For more information, visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.
Individuals with Medicare will benefit from lower prescription drug costs and a redesigned prescription drug program. Benefits include:
- Insulin available at $35/month per covered prescription
- Access to recommended adult vaccines without cost-sharing
- A yearly cap ($2,000 in 2025) on out-of-pocket prescription drug costs in Medicare
- Expansion of the low-income subsidy program (LIS or “Extra Help”) under Medicare Part D to 150% of the federal poverty level starting in 2024
- Medicare Drug Price Negotiation
The Inflation Reduction Act makes Medicare stronger for current and future enrollees. It makes health care more accessible, equitable, and affordable by lowering what Medicare spends for prescription drugs and limiting increases in prices.
Please see the links below for more information on the Inflation Reduction Act.
https://www.cms.gov/inflation-reduction-act-and-medicare
https://www.hhs.gov/inflation-reduction-act/index.html
https://www.hhs.gov/sites/default/files/ira-rx-prices-texas.pdf
Medicare Savings Program (MSP)
MSPs help pay for Medicare premiums and cost-sharing. MSPs are Medicaid-administered programs for Medicare beneficiaries with limited income and assets.
https://www.medicare.gov/basics/costs/help/medicare-savings-programs
MEDICAID
The Centers for Medicare & Medicaid Services (CMS) thanks you for your partnership in helping to share information about Medicaid and Children's Health Insurance Program (CHIP) renewals with people in your community. Your support as a trusted voice in your community has been key to helping people keep health coverage as states return to regular operations after the COVID-19 pandemic. The Medicaid and CHIP Renewals Outreach and Educational Resources webpage includes evergreen language that partners can use to share information about regular Medicaid and CHIP renewals. We encourage partners to continue to explore the refreshed resources and share information with people in your community.
In November 2024, CMS released several pieces of guidance and resources on Medicaid and CHIP renewals. These resources are linked below and can also be found under the “Guidance (SHOs, CIBs, and FAQs)” and “Policy & Operational Resources” sections on Medicaid.gov/Unwinding.
- Informational Bulletin and Slide Deck on Use of Unwinding-Related Strategies to Support Long-Term Improvements to State Medicaid Eligibility and Enrollment Processes: These documents provide states with guidance regarding the continued use of certain streamlined eligibility and enrollment strategies that CMS made available to states to address challenges brought on by the COVID-19 Public Health Emergency (PHE) and the expiration of the continuous enrollment condition.
- Assistant Secretary for Planning and Evaluation (ASPE) Report: Evaluating Medicaid Strategies to Streamline Ex Parte Renewals: This report evaluates certain Medicaid strategies to streamline ex parte renewals.
- Informational Bulletin and Slide Deck on Financial Eligibility Verification Requirements and Flexibilities: These documents remind states about current requirements and state flexibilities in verifying financial eligibility for Medicaid and CHIP in accordance with the Social Security Act and implementing regulations.
- Informational Bulletin on Basic Requirements for Conducting Ex Parte Renewals of Medicaid and CHIP Eligibility: This informational bulletin reminds states about current requirements and expectations for renewing eligibility for Medicaid and CHIP beneficiaries based on reliable information available to the state without contacting the beneficiary, also referred to as an ex parte renewal.
Updates to the Medicaid and CHIP Renewals Outreach and Educational Resources Webpage
Last week, additional resources on the Medicaid and CHIP Renewals Outreach and Educational Resources webpage were updated to include evergreen language that partners can use to share information about regular Medicaid and CHIP renewals, including the Faith-Based Communications Toolkit. This toolkit includes ready-to-use resources to help faith-based organizations share information with their congregations, communities, and people they serve.
CMS continues to review and update the Medicaid and CHIP Renewals Outreach and Educational Resources webpage as needed. We encourage partners to visit the webpage at Medicaid.gov/renewals-outreach-education for the most up to date resources and messaging.
COVERAGE TO CARE (C2C)
Coverage to Care, developed by the Centers for Medicare and Medicaid Services, helps individuals understand their health coverage and access the primary care and preventive services right for them. Stay informed with the latest news and updates on how C2C continues to connect people to important resources and information.
In addition to regular C2C updates we want to use this edition to highlight how to use C2C after Open Enrollment (OE). C2C resources provide critical information to assist consumers with the next steps after enrolling or changing their plan. Some key materials to review after the enrollment period include the Enrollment Toolkit, Roadmap to Better Care, 5 Ways to Make the Most of Your Health Coverage, My Health Coverage at-a-Glance, and Manage Your Health Care Costs.
New C2C Resources
Check out the latest C2C resources helping consumers understand their coverage and the preventive services available. These resources also help partners and providers serve individuals in their community:
- Telehealth: What to Know for Your Family – Learn about the types of care available through telehealth and how you and your family can use this technology for quality care. This resource was updated in September to include broader and more concise language.
- Telehealth for Providers: What You Need to Know – Discover useful information for health care providers about telehealth including how to get started, billing considerations for Medicare and Medicaid, when to use telehealth, and more. This resource was also revised in September to be more evergreen following the end of the COVID-19 PHE and conclusion of Medicaid Unwinding in most states.
College Students Preventive Services Flyer and View Your Path to Better Student Health Poster now available in eight additional languages (Arabic, Chinese, Haitian Creole, Korean, Russian, Spanish, Ukrainian, Vietnamese) on the C2C site. Download the translations from the Get Preventive Care, Resources for Partners and Providers, and View All Resources webpages.
PREVENTING SEASONAL FLU
The best way to reduce risks from seasonal flu and its potentially serious complications is to get a flu vaccine every year. The vaccine prevents millions of illnesses and flu-related doctor’s visits each year.
Everyone 6 months and older should get an annual flu vaccine. People at higher risk of serious flu complications include young children, pregnant people, people with certain chronic health conditions like asthma, diabetes or heart and lung disease, and people 65 years and older.
Visit CDC.gov/flu/prevention/actions-prevent-flu.html to get information on healthy habits to help reduce the risk of seasonal flu and the spread of germs.
Medicare Part B (Medical Insurance) covers the seasonal flu shot once per flu season and additional flu shots if it’s medically necessary. Visit Medicare.gov/coverage/is-your-test-item-or-service-covered to learn more about what Medicare covers.
PROTECTING AGAINST RESPIRATORY VIRUSES
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Respiratory Virus Season: How to Protect Yourself and Others Fall is a great time to make sure you and your family are taking steps to prevent respiratory diseases, including flu, COVID-19, and RSV. CDC’s respiratory virus guidance can help you stay healthy so you can continue to enjoy all the things you love to do this time of year. We recommend that everyone use these core prevention strategies:
You can also choose any or all of these additional strategies to further protect yourself and others: masks, physical distancing, and tests. Every year, respiratory diseases such as flu, COVID-19, and RSV cause hundreds of thousands of hospitalizations and thousands of deaths during the fall and winter virus season. There are more tools than ever to protect ourselves, our families, and our communities from these diseases. Learn More! |
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Respiratory Virus Vaccine Partner Toolkit (Partner with CMS) CMS flu, COVID-19 and RSV partner resource and outreach material toolkit accessible here. Respiratory viruses cause hundreds of thousands of hospitalizations and thousands of deaths during each year’s fall and winter virus season (see HHS). The ideal time to get vaccinated varies by vaccine. The best time to get a flu shot is September and October (see CDC). |
With this funding and under proposed policy action, Health Resources and Services Administration (HRSA)-funded health centers may provide health care services – including chronic disease, mental health, and substance use disorder treatment – to individuals soon to be released from incarceration to support their healthy return to the community.
Research finds that individuals released from prison face an opioid overdose risk up to 10 times the risk of the general public. newsroom.hrsa.gov
NURSING HOME STAFFING CAMPAIGN
Nursing home staffing has a significant impact on the quality of care that residents receive. Feedback from both nursing home staff and residents consistently highlights staffing as their primary concern. In response, the Centers for Medicare & Medicaid Services (CMS) is launching a national Nursing Home Staffing Campaign aimed at increasing the number of nurses working in nursing homes and at the state agencies that inspect nursing homes for compliance with health and safety standards, ultimately better improving and protecting residents’ health and safety.
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We greatly appreciate your partnership in sharing the important health insurance access and wellness resources. Please feel free to use the Speaker Request Form link below if your organization could benefit from an educational training session on Medicare, Medicaid/Children’s Health Insurance and/or the Health Insurance Marketplace. We welcome feedback on how CMS programs are working for individuals and families in the communities you serve. CMS strongly believes in the importance of amplifying local voices and using them to help shape policies.
Please let me know if you have any questions or comments.
Thank you,
Angela Cain
Outreach Specialist (State Lead for MD & DC)
Local Engagement & Administration - Philadelphia
Office of Program Operations & Local Engagement
Centers for Medicare & Medicaid Services
801 Market Street, Suite 9400
Philadelphia, PA 19107-3134
Office Phone: 445-218-0332
Office Cell: 667-458-9467
Email: angela.cain@cms.hhs.gov
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