Top 4 Responsibilities of the Centers for Medicare and Medicaid Services

The Centers for Medicare and Medicaid Services is responsible for providing comprehensive health insurance coverage to millions of Americans each year. The CMS is responsible for providing wide-ranging coverage through different health insurance programs, such as Medicaid and Medicare. Each of these programs provides benefits to certain types of applicants. However, the CMS also offers additional insurance plans through the Health Insurance Marketplace.

Officially, the CMS is part of the U.S. Department of Health and Human Services (HHS). When you view the CMS website, you will see there are many factors to consider about the programs these centers offer. Before you decide which program you should enroll in, it is important that you familiarize yourself with the CMS. Below is a list of the most important responsibilities the CMS has and how this agency serves you. 

1. Learn About the Medicaid Health Insurance Program

One of the CMS medical programs individuals can enroll in is Medicaid. Medicaid health insurance is an income-based assistance program that provides comprehensive coverage to individuals and households throughout the United States. The program is administered through individualized state programs that follow federal guidelines in terms of eligibility requirements, cost-sharing policies and coverage details. 

As a low-income health insurance plan, Medicaid provides health coverage to qualifying recipients at little to no cost. With Medicaid, premium-related costs are reduced or eliminated for participants, as well as other cost-sharing fees such as coinsurance and copayments. 

To qualify for this health insurance program, applicants must meet their states’ income requirements. However, some states impose additional eligibility requirements applicants must meet before they can enroll. For example, some states will only provide insurance coverage to households that include a member who is medically vulnerable. In this instance, “medically vulnerable” refers to a person who is: 

  • Disabled. 
  • A senior citizen. 
  • Pregnant. 
  • A dependent child. 

Similarly to costs and eligibility requirements, states have some say regarding the medical services that are covered through their Medicaid plans. However, there are several medical services that all states must cover with their Medicaid programs. These include general physician visits and laboratory tests. On the other hand, there are other services that states can choose whether or not to include, such as: 

  • Dental benefits.
  • Vision coverage. 
  •  Hearing-related services. 

2. About the Children’s Health Insurance Program (CHIP)

CMS medical responsibilities include providing guidelines for CHIP. Similar to Medicaid, CHIP is administered through state programs that must follow certain federal guidelines and requirements. For that reason, some eligibility requirements, costs and coverage options may vary between states. 

CHIP is critical in providing low-income children and pregnant women with comprehensive health insurance. This program is designed to provide benefits to qualifying children and women that have a family income that is too high to qualify for Medicaid but too low to afford private health insurance. As a result, this is an important program that the CMS helps to facilitate. 

While CHIP is slightly different from one state to another, eligibility requirements throughout the nation are generally based on the same qualifications. For example, state agencies will usually consider: 

  • An applicant’s income level. 
  • The number of people living within the applicant’s household. 
  • The applicant’s citizenship or lawful immigration status. 

Depending on families’ incomes, they may be required to pay premium fees or cost-sharing amounts, including copayments or insurance payments. However, fees associated with CHIP are considerably lower than private health insurance. 

Furthermore, the medical services that are provided through CHIP vary between states, but they are generally comparable to state Medicaid programs. However, pregnant women who receive benefits through CHIP may only use CHIP to access services relating to their pregnancies or unborn children. 

3. Find Out About the Medicare Health Insurance Program

The CMS is responsible for providing Americans with access to health insurance through the Medicare program. The Medicare health insurance program is a federal insurance initiative that offers comprehensive coverage to senior citizens who are at least 65 years of age. Other eligible applicants include individuals who have long-term disabilities. 

Each year, Medicare provides affordable health insurance to millions of enrollees. However, the medical services that a Medicare policy will cover depends on the specific parts of Medicare that a beneficiary has chosen to enroll in. For example, individuals can enroll in: 

  • Medicare Part A, which is also known as “hospital insurance.” This part provides coverage for inpatient and outpatient hospital care, as well as some health visits or hospice care.  
  • Medicare Part B, which provides additional coverage options for medical services. Examples of services that are generally covered with Part B include visits with physicians, preventative services and outpatient services. 
  • Medicare Part D, which provides prescription drug coverage. Enrollees can add Part D to Part A or Part B policies.  
  • Medicare Part C, which is known as “Medicare Advantage.” Part C allows beneficiaries to enroll in private health insurance plans for Part A, B and D benefits. These plans may also include access to other benefits, such as dental or vision care. The available Medicare Part C plans and providers vary by location. 

Unlike other CMS medical programs, Medicare is not considered an income-based insurance. However, those with exceedingly high income may have a higher premium fee. 

4. Learn About the Health Insurance Marketplace 

The CMS are also responsible for assisting consumers with shopping for affordable health insurance options. To accomplish this, the CMS operates the Health Insurance Marketplace, which can be found online. Some states have chosen to operate their own marketplaces, but otherwise the CMS manages this service. 

The Health Insurance Marketplace is a great starting point for anyone who is exploring their health care options. First, the marketplace helps to connect applicants with insurance providers within their local communities. Next, applicants can view the insurance policies that are available to them. Furthermore,  applicants are notified if they may be eligible for other forms of coverage. If an applicant may qualify for Medicare, Medicaid or CHIP, the applicant is notified and the applicant’s information is automatically sent to his or her state agency. 

Additionally, low-income applicants can receive additional benefits by purchasing a private insurance plan through the marketplace. Families that are struggling financially may be eligible for premium tax credits that can be applied to reduce premium costs and cost-sharing fees. Therefore, applicants can access many benefits when they explore the different CMS medical insurance options available.