What Is the Centers for Medicare & Medicaid Services (CMS)?
The Centers for Medicare & Medicaid Services (CMS) is the agencywithin the U.S. Department of Health and Human Services (HHS)that administers the nation’s major healthcare programs. The CMS oversees programs including Medicare, Medicaid, the Children’s Health Insurance Program (CHIP),and the state and federal health insurance marketplaces. CMS collects and analyzes data, produces research reports, and works to eliminate instances of fraud and abuse within the healthcare system.
Key Takeaways
- The Centers for Medicare & Medicaid Services (CMS) is a federal agency that administers the nation’s major healthcare programs, including Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP).
- CMS collects and analyzes data, produces research reports, and works to eliminate instances of fraud and abuse within the healthcare system.
- CMS aims to provide a healthcare system with better care, access to coverage, and improved health.
- CMS releases updated Medicare premium and deductible information each year.
How the Centers for Medicare & Medicaid Services (CMS) Works
On July 30, 1965, then-President Lyndon B. Johnson signed into law a bill that established the Medicare and Medicaid programs. In 1977, the federal government established the Health Care Finance Administration (HCFA) as part of the Department of Health, Education, and Welfare (HEW). The HCFA was later named the Centers for Medicare & Medicaid Services (CMS) in July 2001. CMS now manages many important national healthcare programs that affect the lives of millions of Americans.
The agency says it is "dedicated to advancing health equity, expanding coverage, and improving health outcomes." CMS is headquartered in Maryland and has 10 regional offices throughout the United States located in Atlanta, Boston, Chicago, Dallas, Denver, Kansas City, Mo., New York, Philadelphia, San Francisco, and Seattle. There are even offices located outside of the U.S., in Puerto Rico and the U.S. Virgin Islands.
The CMS manages the Administrative Simplification Standards of the Health Insurance Portability and Accountability Act (HIPAA). The use of Administrative Simplification Standards strives to implement the adoption of national electronichealthcare records, guarantee patient privacy and security, and enforce HIPAA rules. CMS overseesquality inclinical laboratories and long-term care facilities, as well as provides oversight of thehealth insurance exchanges.
Special Considerations
Because healthcare costs continue to rise, Medicare premiums usually increase each year. CMS projects that healthcare spending is estimated to grow by 5.4% each year from 2019 to 2028. This means healthcare will cost an estimated $6.2 trillion by 2028.
Since Part B premiums are deducted from the Social Security benefits of Medicare recipients, it’s important that people remain informed and understand how these premiums work. This is why CMS releases information annually about premiums and deductibles.
Types of CMS Programs
Through its Center for Consumer Information & Insurance Oversight, CMS plays a role in the federal and state health insurance marketplaces by helping to implement Affordable Care Act (ACA) laws and provisions related to private health insurance, and providing educational materials to the public.
CMS plays a role in insurance marketplaces by helping to implement the Affordable Care Act’s laws related to private health insurance.
Medicare
Medicare is a taxpayer-funded program for people ages 65 and older. Eligibility requires the individual to have worked and paid into the system through payroll taxes. Medicare also provides health coverage for people with recognized disabilities and specific end-stage diseases asconfirmed by the Social Security Administration (SSA).
Medicareconsists of four parts, titled A, B, C, and D. Part A covers inpatient hospital, skilled nursing, hospice, and home services. Medical coverage is provided under Part B and includes physician, laboratory, outpatient, preventive care, and other services. Medicare Part C, or Medicare Advantage, is a combination of parts A and B. Part D, which was signed in 2003 by then-President George W. Bush, provides coverage for drugs and prescription medications.
Medicare enrollees share costs with taxpayers through premiums and out-of-pocket expenditures as noted above.
Medicaid
Medicaid is a government-sponsored program that provides assistance for healthcare coverage to people with low incomes. The joint program, funded by the federal government and administered at the state level, varies. Patients receive assistance paying for things like doctor visits, long-term medical andcustodial carecosts, hospital stays, and more.
Applicants who want to be considered for Medicaid can apply online through the Health Insurance Marketplaceor directly through their state’s Medicaid agency.
CHIP
The Children’s Health insurance Program (CHIP) is offered to parents of children under age 19 who make too much to qualify for Medicaid but can’t afford regular health insurance. The income limits vary, as each state runs a variation of the program with different names and different eligibility requirements.
Many of the services provided by CHIP are free, including doctor visits and checkups, vaccinations, hospital care, dental and vision care, lab services, X-rays, prescriptions, and emergency services. But some states may require a monthly premium, while others require a co-pay.
The CARES Act of 2020
On March 27, 2020, then-President Donald Trump signed a$2 trillion coronavirus emergency stimulus package, called the CARES (Coronavirus Aid, Relief, and Economic Security) Act, into law.It expands Medicare’s ability to cover treatment and services for those affected by COVID-19. The CARES Act also:
- Increases flexibility for Medicare to cover telehealth services
- Authorizes Medicare certification for home health services by physician assistants, nurse practitioners, and certified nurse specialists
- Increases Medicare payments for COVID-19-related hospital stays and durable medical equipment
For Medicaid, the CARES Act clarifies that non-expansion states can use the Medicaid program to cover COVID-19-related services for uninsured adults who would have qualified for Medicaid if the state had chosen to expand. Other populations with limited Medicaid coverage are also eligible for coverage under this state option.
What Does the Centers for Medicare & Medicaid Services (CMS) Do?
The Centers for Medicare & Medicaid Services (CMS) provides health coverage to more than 100 million people through Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), and the Health Insurance Marketplace.
Is CMS the Same as Medicare?
No. The Centers for Medicare & Medicaid Services (CMS) is part of the U.S. Department of Health and Human Services (HHS) and is not the same as Medicare. Medicare is a federally run government health insurance program, which is administered by CMS.
Where Is CMS Based?
CMS is headquartered in Maryland and has 10 regional offices throughout the U.S. located in Atlanta, Boston, Chicago, Dallas, Denver, Kansas City, Mo., New York, Philadelphia, San Francisco, and Seattle.
The Bottom Line
The Centers for Medicare & Medicaid Services (CMS) is a federal agency that administers the nation’s major healthcare programs, including Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). It collects and analyzes data, produces research reports, and works to eliminate instances of fraud and abuse within the healthcare system.
