What is CMS?

Government organizations sure love their acronyms, right? It can be hard to keep all of them straight. Today, we’re going to look at just one of those: CMS. We’ll learn who they are and what they do.

What is CMS?

CMS stands for The Centers for Medicare & Medicaid Services. CMS is an agency within the U.S. Department of Health and Human Services. They administer the nation’s major health care programs.

CMS was created in 1977, although it was originally called the Health Care Finance Administration (HCFA). The name changed later. Their job is to provide health coverage to more than 100 million people nationwide. CMS seeks to strengthen and modernize the United States’ health care system and to provide access to high quality care and improved health at lower costs.

What programs does CMS oversee?

CMS oversees Medicare, Medicaid, the Children’s Health Insurance Program, and the Health Insurance Marketplace. They also oversee state and federal health insurance marketplaces. It is important to note that although Medicare is a federally regulated program, Medicaid and CHIP are administered at the state level. CMS provides guidance and oversight to these programs, but they do not run them.

What does CMS do?

CMS also manages the Administrative Simplification Standards of the Health Insurance Portability and Accountability Act (HIPAA). The Administrative Simplification Standards are working on making the nation’s healthcare records electronic for easier and secure communication between physicians and to unify care between providers.

Another thing CMS does is enforce HIPAA rules. HIPAA guarantees patient privacy and security. CMS also oversees quality standards in clinical laboratories and long-term care facilities. Everything they do is to ensure high-quality standards nationwide for all who rely on their services.

CMS programs

CMS, through the Center for Consumer Information & Insurance Oversight, play an important role in state and federal insurance marketplaces by helping implement the Affordable Care Act’s (ACA) laws concerning private health insurance and providing educational materials to the public.

Medicaid

Medicaid is a government-sponsored program that helps with healthcare coverage for low-income people and those with disabilities. The program is jointly funded at the federal and state level, although it is administered at a state level. Medicaid helps cover doctor visits, long-term care and hospital stays.

Children’s Health Insurance Program (CHIP)

CHIP is designed to provide health insurance to children 18 and under. It’s designed for families whose income is too high to qualify for Medicaid but not enough to be able to afford private insurance. Requirements vary by state, so it’s important to check with your state health department if you or a loved one is looking at CHIP.

Medicare

Medicare is a taxpayer-funded health care program that is designed to help Americans age 65 and older. To be eligible for Medicare, you’ll have paid into the system through payroll tax as you worked. Medicare also has disease-specific eligibility for those who do not meet the age requirement but have certain critical diseases.

Medicare has different parts that cover different care. Part A covers hospital and emergency services. Part B covers medical insurance for doctors and outpatient care. Part D covers prescription drugs and is offered by private carriers. Additional supplements and plans are available.

Conclusion

Understanding CMS helps you figure out what health care option is right for you. It also helps with understanding the complexity of the American health care system and the systems in place to help Americans get the coverage they need.

If you are interested in learning more about Medicare and your Medicare options, call us to today to set up a zero-cost, commitment-free consultation with one of our licensed insurance agents.

PlanEnroll is a brand operated by Integrity Marketing Group, LLC and used by its affiliated licensed insurance agencies that are certified to sell Medicare products. PlanEnroll is not endorsed by the Center for Medicare & Medicaid Services (CMS), the Department of Health and Human Services (DHHS) or any other government agency.