A Guide to the Centers for Medicare & Medicaid Services (CMS)
The Centers for Medicare & Medicaid Services (CMS) is a federal agency that provides health coverage to millions of people. It oversees programs like Medicare, Medicaid, and CHIP.
The CMS works closely with the entire healthcare community to improve the equity, quality, and outcomes within the healthcare system.
What is CMS?
CMS is the federal agency that helps provide health coverage for more than 160 million people across the United States. It oversees the following health insurance programs:
Medicare
Medicaid
Children's Health Insurance Program (CHIP)
Health Insurance Marketplace
CMS aims to strengthen and modernize the United States healthcare system and provide access to high quality care and improved health at lower costs.
About Medicare
Medicare is a federal health insurance program for people 65 years old and over. Those under 65 years old who have an eligible illness or disability may also qualify for coverage through Medicare.
Medicare has four parts that offer different coverage for your healthcare needs:
Part A: This is also known as hospital insurance. It covers inpatient care in facilities like hospitals and skilled nursing facilities. Part A also covers some home healthcare and hospice care.
Part B: This is also known as medical insurance. It covers outpatient care and services you might receive from a doctor, specialist, or other healthcare professional. Part B also covers durable medical equipment (DME) and some home healthcare.
Part C (Medicare Advantage): This is an alternative to Original Medicare (parts A and B). It offers the same coverage but is provided by Medicare-approved private insurance companies. Medicare Advantage plans also typically include prescription drug coverage (Part D) and additional benefits, such as vision, hearing, and dental.
Part D: This offers prescription drug coverage. Part D plans are offered through Medicare-approved private insurance companies. If you have Original Medicare, you can purchase a stand-alone Part D plan from one of these companies.
The CMS oversees and manages the Medicare program. The Social Security Administration (SSA) manages Medicare enrollment and income-related monthly adjustment amounts (IRMAA) for Part B and Part D.
About Medicaid
Medicaid is a health insurance program that is run by individual states according to federal requirements. It is funded by both the state and federal governments.
Medicaid provides health coverage to around 71.1 million people, including:
adults with lower incomes
pregnant individuals
children
older adults
people with disabilities
It is possible for you to qualify for coverage from both Medicaid and Medicare at the same time. This can help reduce or eliminate your out-of-pocket costs.
About Children's Health Insurance Program (CHIP)
CHIP helps provide comprehensive health insurance benefits to children. Each state runs its own CHIP program, which means that the exact coverage and benefits may vary.
While states can choose what benefits to offer in their CHIP program, there are certain healthcare services they must include:
dental
vaccines
behavioral health
well-baby and well-child visits
About the Health Insurance Marketplace
The Health Insurance Marketplace can help you find health coverage if you don't already have it through Medicare, Medicaid, or employment.
It can also help you:
find answers to questions about health insurance
compare health insurance plans for affordability and coverage
find out if you are eligible for tax credits for private insurance or health programs like Medicare and Medicaid
enroll in a health insurance plan that meets your needs
Summary
The Centers for Medicare & Medicaid Services (CMS) is the federal agency that oversees health coverage programs like Medicare, Medicaid, and the Children's Health Insurance Program (CHIP). It has a mission to strengthen the United States health system and provide access to high quality care and improved health at lower costs.
The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.
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