The Centers for Medicare & Medicaid Services (CMS) is a federal agency that administers both Medicare and Medicaid.
CMS also manages CHIP, a health insurance program for children under 18.
CMS.gov features information about Medicare and Medicaid eligibility and coverage.
CMS and Medicare are not the same. CMS oversees Medicare and several other healthcare programs, while Medicare focuses on delivering quality care to Americans 65 and older.
CMS.gov is a great resource if you’re looking for more information about Medicare, Medicaid or dual eligibility. This federal website gives you up-to-date information to help you make the right decision about your healthcare coverage.
But what exactly is CMS, and who qualifies for services? Read on to find the answers to all your CMS questions.
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CMS and Medicare are both federal agencies focused on health insurance, but they are not the same thing. Let’s take a look at how they’re different.
The Centers for Medicare & Medicaid Services (CMS) is a federal agency that oversees the federal Medicare program. CMS also works with state governments to manage Medicaid and the Children’s Health Insurance Program (CHIP). CMS provides oversight for all three of these healthcare programs. But CMS does not offer healthcare plans.
Medicare, on the other hand, is the federal health insurance agency that offers Medicare insurance for older adults. Medicare includes Original Medicare, Medicare Advantage, Medicare prescription drug coverage and Medicare Supplement plans.
What does the CMS agency do?
CMS is part of the federal Department of Health and Human Services. CMS administers the country’s biggest healthcare programs, including:
- Children’s Health Insurance Program (CHIP)
CMS updates Medicare Part A and Part B financial information each year, including setting Medicare premiums and yearly deductibles. That’s why Original Medicare premiums, deductibles and copayments are the same in every state.
CMS also provides oversight to state and federal health insurance agencies, ensuring that Americans can access the healthcare they need at an affordable price. All healthcare providers who accept Medicare coverage must comply with CMS guidelines.
Looking for the facts? CMS collects and analyzes healthcare data in addition to compiling nationwide research. For example, CMS tracks how many Americans are enrolled in Medicare and what services they access the most. Having this data helps healthcare providers offer better care, improve access to healthcare coverage and even improve overall health outcomes.
CMS also strives to eliminate any instances of abuse or fraud within the healthcare system.
When should I use CMS.gov vs. Medicare.gov?
CMS.gov is the official government website for the Centers for Medicare and Medicaid Services. It gives you up-to-date information about Medicare, Medicaid, CHIP and other CMS initiatives. When you’re looking for more information about any of these services, CMS.gov is a good place to look.
CMS.gov also provides:
- Helpful information about dual eligibility for Medicare and Medicaid.
- General information about Medicare, Medicaid and CHIP coverage.
- Information on filing appeals and grievances.
- CMS forms for healthcare providers.
- Stats on Medicare beneficiaries in each state and nationwide.
- Stats on how many Americans have a Medicare Advantage plan or a Part D prescription drug plan.
Are you looking for more specific information about Medicare? Then Medicare.gov is the place to go. The official Medicare site provides helpful information and services such as:
- A complete database of Medicare-covered services. You can access information on every service that’s covered by Original Medicare, along with a breakdown of copayments and out-of-pocket costs.
- Medicare premiums and deductibles.
- Medicare enrollment information.
- The Medicare plan finder connects you with plans in your area and makes it easy to compare plans.
- An online Medicare account where you can manage your healthcare claims or find out more about your Medicare coverage.
CMS manages three important federal healthcare programs that provide healthcare to millions of Americans. CMS ensures that these programs offer high-quality care and improves access to coverage.
- Medicare: CMS oversees Medicare, the federal health insurance agency offering health insurance to Americans over 65. Original Medicare covers inpatient hospital care, skilled nursing facility care, outpatient medical care and some preventative services durable medical equipment. Medicare Advantage offers the same coverage and additional coverage like dental and vision.
- Medicaid: CMS manages Medicaid, a government-funded healthcare program for low-income adults. Medicaid covers doctors visits, medical care, hospital care and more. Medicaid programs vary by state, so coverage changes based on where you live.
- CHIP: The CMS also administers the Children’s Health Insurance Program (CHIP). If a child doesn’t have health insurance, CHIP steps in to offer healthcare coverage to uninsured children under 18. This low-cost healthcare may cover preventative services and checkups, hospitalizations, emergency room visits, prescriptions and immunizations. Just like Medicaid, CHIP coverage varies by state.
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Each of the health insurance programs administered by CMS has different eligibility requirements. Here are some of the main things to keep in mind if you’re accessing CMS services.
- Medicare: Since Medicare provides insurance for older adults, most eligible adults are over age 65. U.S. citizens and permanent residents over 65 qualify for Medicare coverage. However, adults under 65 with qualifying disabilities also can get Medicare coverage.
- Medicaid: Medicaid eligibility is based on income. This program is available to all low-income adults, families and children. You can check your eligibility by visiting Medicaid.gov. Adults of any age can qualify for Medicaid. And if you’re over 65, you could qualify for both Medicare and Medicaid.
- CHIP: Some children may not have health insurance coverage. For example, their family income may be too high to qualify for Medicaid, but too low to comfortably afford other health insurance. CHIP steps in to offer healthcare coverage to uninsured children under 18. U.S. citizens and permanent residents can get CHIP coverage.