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Your monthly compilation of upcoming events, resources, state highlights and more!





Health Insurance Marketplace




Assister digest email header




*Welcome back to the Transitions in Coverage Assister Monthly Digest!*

As states complete regular eligibility reviews and renewals for Medicaid and the Children’s Health Insurance Program (CHIP), assister communities are vital in helping consumers who have recently found out they’re no longer eligible navigate their health coverage options. This digest is intended to equip assisters with resources and tools to connect with consumers in need of assistance.

*"Have questions?"*" Certified Application Counselors (CACs) should contact the CAC mailbox at ""CACQuestions@cms.hhs.gov" <CACQuestions@cms.hhs>", Enrollment Assistance Personnel (EAPs) should contact ""EAPQuestions@cms.hhs.gov" <EAPQuestions@cms.hhs.gov>", and"" Navigators should reach out to their Project Officer."

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*Reminder:* Use communication and engagement methods tailored to the specific needs of your consumers, which include (but aren’t limited to) phone calls, emails, and texts. Additionally, ensure that consumers _enter your assister ID_ when they complete the Marketplace application, and make sure that consumers are aware of your role as a CAC by identifying you as a CAC on the application. Your assister ID, whether CAC, Navigator or EAP, is a 13-digit alphanumeric ID assigned to you by your organization leadership. Including your assister ID will help CMS better understand the support that the assister community provides and continue to improve the consumer experience.



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"Important transitions in coverage resources on REGTAP and CMS.gov are located at the "bottom of this resource. [ #Resources ] "You can also view past editions of this digest ""here" [ https://regtap.cms.gov/reg_library.php?libfilter_keyword=transitions%20in%20coverage&libfilter_resource=11 ]"."

*"In Case You Missed It: "*"The Complex Case Web Form allows Navigators, CACs, EAPs, and Advocates (using the “Other” category) to submit a complex case for investigation by the Complex Case Help Center (CCHC) team. A complex case is an issue involving a single consumer or tax household where the assister has not been able to resolve a specific issue on the consumer or tax household’s application for Marketplace coverage. Complex cases are not policy questions or general questions about the Marketplace application. Assisters must first report the complex case issues to the Marketplace Call Center, unless they are reporting cases of unauthorized enrollments or unauthorized plan switches, which do not require contacting the Marketplace Call Center. "

"Click ""here" [ https://mats-cms-ccrms.my.salesforce-sites.com/complexcase ]" to access the Complex Case Web Form, and ""here" [ https://www.cms.gov/marketplace/technical-assistance-resources/training-materials/complex-case-user-guide.pdf ]" to access Complex Case Web Form navigation instructions."



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Upcoming: The Health Insurance Marketplace® Opens November 1!

Marketplace Open Enrollment Period kicks off for the 12th year on *November 1*! Consumers who need to sign up for health insurance coverage should visit HealthCare.gov or CuidadoDeSalud.gov to enroll in health coverage. Consumers who enroll by midnight on December 15 can get full-year coverage that starts January 1, 2025. Otherwise, their coverage will begin on February 1. Consumers can enroll until January 15, 2025.

For additional information on updates and improvements for HealthCare.gov Marketplace Open Enrollment, consult CMS’s “What’s New” fact sheet” [ https://www.cms.gov/newsroom/fact-sheets/marketplace-2025-open-enrollment-fact-sheet ], press release [ https://www.cms.gov/newsroom/press-releases/affordability-and-choice-anchor-biden-harris-administrations-launch-window-shopping-12th ], and infographic [ https://www.cms.gov/files/document/2025-open-enrollment-infographic.pdf ].

Additional details are also available in:


* The Plan Year 2025 Qualified Health Plan and Premiums in HealthCare.gov States – Report, Appendix Tables, and Methodology [ https://www.cms.gov/marketplace/resources/data/qualified-health-plan-choice-premiums-healthcaregov-states ].
* The Plan Year 2025 Health Insurance Marketplace® Public Use Files [ https://www.cms.gov/marketplace/resources/data/public-use-files ].
* Information on Quality Ratings for Plan Year 2025 [ https://www.cms.gov/medicare/quality/health-insurance-marketplace-initiatives ].
* The Plan Year 2025 Projected Health Insurance Exchange Coverage Map [ https://www.cms.gov/marketplace/about/exchange-coverage-maps ].
* The Plan Year 2025 State-based Marketplace Open Enrollment Fact Sheet [ https://www.cms.gov/files/document/state-exchange-oe-chart-py-2025.pdf ].

Affordability and Choice Anchor Biden-Harris Administration’s Launch of Window-Shopping for the 2025 Open Enrollment Period

Building on the Biden-Harris Administration’s historic efforts to make high-quality, affordable health care coverage accessible for all Americans, CMS launched window-shopping for millions of consumers to preview health coverage options available through the 2025 Open Enrollment Period for the HealthCare.gov Marketplaces. Open enrollment begins November 1 for HealthCare.gov and the 20 states that run their own marketplaces.

*Theme Weeks of Action*

During the Open Enrollment Period, “Theme Weeks of Action” will be available each week for partners to focus on specific audiences. We encourage partners to use the resources available, develop an outreach plan, and share with your networks. Keep an eye out for information regarding the theme weeks of action!

*2024 Open Enrollment Period HealthCare.gov Scheduled Maintenance Windows*

Every year, CMS establishes scheduled maintenance windows for HealthCare.gov. Similar to operations for other IT systems, these scheduled maintenance windows are how we update and improve our systems to run optimally and are the normal course of business. Consumer access to HealthCare.gov will be limited while systems are updated. Maintenance will only occur when deemed necessary to provide consumers with a better shopping experience. The purpose in scheduling these times is to minimize any consumer disruption.

Like the last several years, we are sharing the maximum potential windows of scheduled maintenance on HealthCare.gov for the upcoming Open Enrollment period to allow agents, brokers, assisters, and states to plan in advance of Open Enrollment.

It is important to note that these times are the maximum windows for scheduled maintenance activities that require limiting or restricting consumer access to HealthCare.gov. Consistent with past years, the actual maintenance periods may be shorter. As with all IT systems, there is a possibility that unscheduled work will be needed, in which case CMS will use existing channels to notify stakeholders.

Potential maximum scheduled HealthCare.gov maintenance windows for this upcoming Open Enrollment period are [ https://www.cms.gov/files/document/healthcaregov-scheduled-maintenance-windows.pdf ]:


* Friday, November 1, 2024 – early morning to make final preparations ahead of the state of the Open Enrollment period.
* Sundays, November 3, November 17, December 8, and December 22 – midnight to 7 a.m.

*Assister Support Resources*

The resources below are available to help answer complex questions or issues assisters and consumers may encounter.


* The Marketplace Call Center: 1(800) 318-2596 (TTY: 1(855) 889-4325)
* The Marketplace Call Center helps consumers enroll in health coverage and provides frontline support for consumers experiencing Marketplace eligibility or plan selection issues.

* Assister-Specific Mailboxes [ #questions ]
* Complex Case Webform [ #WebForm ]

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New! Plan Year 2025 Assister Certification Training Modules are Now Available!

In preparation for the Marketplace PY 2025 Open Enrollment Period, which begins November 1, 2024, CMS has updated the Assister Certification Training curriculum. This training is hosted on the Marketplace Learning Management System (MLMS); the online web-based training platform for assisters providing application and enrollment assistance to consumers in Federally-Facilitated Marketplaces (FFMs) and State-based Marketplaces using the Federal platform.

The MLMS can be accessed through the CMS Enterprise Portal. You can find training presentations and additional resources, such as Frequently Asked Questions (FAQs) and MLMS Quick Reference Guides at the following link: Assister Training Materials [ https://www.cms.gov/marketplace/in-person-assisters/training-webinars/training ].


* *New users* register here: New User Registration [ https://portal.cms.gov/ ]
* *Existing users* can login at: Existing User Registration [ https://portal.cms.gov/ ]

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Consumers May Still be Eligible for a Special Enrollment Period!

The Unwinding Special Enrollment Period (SEP) extends through November 30, 2024. This SEP is in place to help consumers maintain coverage as they transition from Medicaid or Children’s Health Insurance Program (CHIP) coverage into a Marketplace plan. Assisters like you are key to helping these consumers transition smoothly. 

*The Unwinding SEP may be available to consumers who:*


* Live in states with Marketplaces served by the HealthCare.gov platform.1
* Submit a new application or update an existing HealthCare.gov application between March 31, 2023, and November 30, 2024, and attest that they have lost Medicaid or CHIP coverage between the same time period.

Consumers who are eligible for the Unwinding SEP will have 60 days after they submit their application to select a plan with coverage that will start on the first day of the month after they select a plan. Click here [ https://www.medicaid.gov/resources-for-states/downloads/extn-sep-cnsmrs-lsg-chip-cvrg-adndm-faq.pdf ] for more information on the Unwinding SEP. This document is an addendum to the original FAQ, which is available for reference here [ https://www.cms.gov/technical-assistance-resources/temp-sep-unwinding-faq.pdf ].

1Georgia consumers are eligible for the Unwinding SEP and should use Healthcare.gov for 2024 coverage applications, even though Georgia has a state-based marketplace for 2025 coverage applications.

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PY 2026 Payment Notice Comment Period

On October 4, 2024, CMS issued the proposed “Notice of Benefit and Payment Parameters" for the 2026 PY. It proposes standards for the Health Insurance Marketplaces, as well as for health insurance issuers, brokers, and agents who connect millions of consumers to Affordable Care Act (ACA) coverage. The rule proposes additional safeguards, beginning in 2025, to protect consumers from fraudulent changes to their health care coverage, as well as options to ensure the integrity of the FFM. Additionally, if finalized as proposed, the rule would make it easier for consumers to understand their costs and enroll in coverage through HealthCare.gov beginning in PY 2026.

To read the proposed rule and issue a comment, click here [ https://www.federalregister.gov/public-inspection/2024-23103/patient-protection-and-affordable-care-act-notice-of-benefit-and-payment-parameters-for-2026-and ]. The proposed 2026 Payment Notice comment period closes on November 12, 2024.

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Marketplace Assister Webinars and More

The Marketplace Assister 2024 Webinar Series has ended, but the 2025 Webinar Series is coming soon to REGTAP; stay tuned for updates. Once the series becomes available, you can log into your REGTAP account and register for the series under "Training Events." If you do not already have a REGTAP account, visit this link [ https://regtap.cms.gov/register.php ] and select “Create an Account” before registering for the series. Webinars provide a unique opportunity for you to learn about unwinding topics that can help you support consumers who might have recently lost or will lose Medicaid or CHIP coverage.

For complete instructions for how to register for webinars, click here [ https://content.govdelivery.com/landing_pages/46044/315d75855de61a4dd08982899adf603b ]. Resources from past webinars can be found here [ https://www.cms.gov/marketplace/in-person-assisters/training-webinars/webinars ].

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CAC Designated Organization (CDO) Office Hours

The CMS CDO Program Office is hosting CDO Office Hours, which are monthly technical support calls for CDO leadership contacts (Organization Senior Official, CAC Project Director, and Secondary Contact) who may need assistance with technical aspects of the CDO Program.

These calls will give CDOs the opportunity to raise questions with CMS subject matter experts on issues they may be experiencing with the CDO Program such as, but not limited to:


* Using the Organization Maintenance Web Form (OMWF),
* Updating your CAC Roster,
* Renewing your CMS-CDO agreement or signing your agreement with DocuSign, or
* Annual assister certification training issues.

CMS hosts these CDO Office Hours calls the *second Thursday of the month from 2 p.m.-3 p.m. E.T.*

If your organization is interested in attending these office hours, CDO leadership should keep an eye out for reminder emails which will be sent the Monday before each call, and will include the Zoom link, meeting ID, and passcode. For questions, please send an email to cacquestions@cms.hhs.gov.

Additionally, please be on the lookout for new engagement opportunities that will give you an opportunity to discuss transitions in coverage topics in more detail with CMS and other assisters.

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Assister Success Story

Assisters like you are essential to keeping consumers connected to the coverage they need.

In this section, we share examples of positive feedback from consumers you’ve assisted to showcase the impact of your reach. If you are aware of a success story from a consumer, please share them at the appropriate email addresses listed above [ #questions ].

This month, we heard from an assister organization that helped a patient reenroll in coverage and maintain her vital medical treatment. To read the full story and learn more about the incredible impact of assisters like you, click here [ https://content.govdelivery.com/landing_pages/46161/89f8f9dab5cc6db7e590da9b36fed314 ]. [ https://content.govdelivery.com/landing_pages/46161/89f8f9dab5cc6db7e590da9b36fed314#Feb2024 ]

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Truth and Myth: Marketplace Effective Dates

Each month, we’ll feature a new key fact or question we’ve identified using your feedback to help you assist consumers securing coverage.

This month, we’re focusing on plan effective date timelines. To view October’s fact and myth, visit this page [ https://content.govdelivery.com/landing_pages/46163/6a084f265e23138f287d911a28d47b20 ].

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Key Resources

*"REGTAP Resources"*


* This job aid [ https://regtap.cms.gov/reg_library_openfile.php?id=4197&type=l ] provides information and guidance necessary for assisters like you to help consumers understand pregnancy and newborn health coverage options.
* Refer to this presentation [ https://regtap.cms.gov/reg_library_openfile.php?id=5589&type=l ] for information regarding best practices for assisters on handling personally identifiable information.
* This presentation [ https://regtap.cms.gov/reg_library_openfile.php?id=4067&type=l ] provides tips for working with outside organizations, such as other assisters, agents and brokers, and tax support organizations.

*"CMS.gov Resources"*


* This resource [ https://www.cms.gov/files/document/underserved-communities-teaching-guide-0192024.pdf ] provides in-depth insight and guidance for assisting underserved communities. This guide explores cultural competency and barriers to care, along with tips and tricks to understanding low health literacy and health disparities.
* The Marketplace Application Checklist [ https://www.cms.gov/marketplace/outreach-and-education/marketplace-application-checklist.pdf ] provides an easy to understand list of everything consumers need to have in order to apply for or re-enroll in Marketplace coverage.
* Check out these recently updated videos for a step-by-step walkthrough of how to help consumers fill out the latest version of the HealthCare.gov application.
* Households seeking financial assistance [ https://youtu.be/mVkBSP9HKO0?si=U0R6Y7V2m1zYeIZ- ]
* Households not seeking financial assistance [ https://youtu.be/Dvd36cQWUgM?si=L2n7D95avKfR2ZXR ]
* How to answer optional demographic questions [ https://www.youtube.com/watch?v=8BvEtcdXDY4&list=PLaV7m2-zFKpgUK9AqdbnOdW69-WwodvRj&index=27 ]

* Check out the updated Transitions in Coverage Guide for Marketplace Assisters [ https://www.cms.gov/files/document/transitions-coverage-guide-marketplace-assisters.pdf ] to review important Unwinding SEP guidance, best practices for assisting consumers transitioning coverage, talking points that answer common consumer questions, and more!
* This resource [ https://www.cms.gov/marketplace/technical-assistance-resources/c2c-roadmap.pdf ] is a roadmap with guidance for connecting consumers to the right coverage for them. With it, you can walk consumers through every step of the process for receiving care from identifying a need for care to what happens after their appointment.

*"Medicaid.gov Resources"*


* For more resources about transitions in coverage, visit the Medicaid Renewals and Outreach Education page [ https://www.medicaid.gov/resources-for-states/coronavirus-disease-2019-covid-19/unwinding-and-returning-regular-operations-after-covid-19/index.html#Marketplace ]. On this page you’ll find resources that can help you reach and communicate with healthcare professionals, children and families, and members of special populations, as well as general FAQs and best practices for transitions in coverage.



















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