What are the Centers for Medicare & Medicaid Services (CMS)

The Centers for Medicare & Medicaid Services (CMS) collectively make up a federal agency previously called the Health Care Financing Administration.  This agency works under the Department of Health and Human Services, or DHHS.  This agency partners with the governments of the States to administer the State Children’s Health Insurance Program in addition to Medicaid.  This agency is in charge of the Medicare program, which is available to citizens over 65 years of age.  Some citizens under 65 can also qualify for Medicare if they meet certain criteria. 

First, let’s take a look at Medicare in more depth.  As previously stated, Medicare is available to people 65 or older and those younger who meet specific qualifications.  Medicare is divided into two sections — Medicare Part A and Medicare Part B.  Medicare Part A covers inpatient hospital stays, home healthcare, nursing home residency and hospice care.  Medicare Part B, on the other hand, covers outpatient doctor visits, certain types of medical equipment, and various preventative screenings.

Then there’s Medicaid.  Medicaid is state administered and is a medical coverage program for low income families.  Not everyone will qualify for Medicaid, even if they are low income.  You will need to check with your state to find out what the requirements are.  Medicaid is often awarded to pregnant women and children from low income families.  Disabled individuals may also be able to obtain Medicaid coverage.  Most of the time, people on Medicaid are responsible for a small co-payment when receiving medical services or prescription medications.

The State Children’s Health Insurance Program is unique in that it is for children who do not have any other means of medical coverage.  For example, certain families may make too much money to qualify for Medicaid yet cannot afford any other type of health insurance.  For these cases, the SCHIP steps in and gives the children medical coverage.  SCHIP covers various things such as annual checkups, sick child visits, diagnostic tests, inpatient and outpatient hospital stays, prescription medications and more.  You can learn more about this program, and the others mentioned in this article, from your state administration office.

5 Responses to What are the Centers for Medicare & Medicaid Services (CMS)

  • Susan Brammer says:

    Medicaid needs some real help and knowledge of health and medicine not just how to keep one from getting their medications so they can end up in the hospital and then cost the service more. I have spent all morning and now afternoon trying to find out who my caseworker is and why some prior authorization is needed on a medicine I had 2 refills left for and that I have been taking for almost 20 years to help control my seizures. Now 35 minutes after I was needing that medicine I still can’t get a # to call that isn’t just another machine and no approval has come through to the pharmacy for me to get my necessary medications. This is uncalled for and the whole system needs to spend time learning how to do something besides push the hold button on the phone or put on those annoying recordings.

  • Rita says:

    How come it is so difficult to find out why a prescription isn’t covered? Or who your caseworker is? My disabled brother-in-law needs some costly chemo drugs and has no income other than Social Security-is on Medicare and Medicaid-needs to come up with $ 300 every three weeks to get this oral scrip
    Alternative is IV at the Cancer Clinic which will cost ten times as much and Medicare and Medicaid will have to pay for all of it. Very frustrating.

  • Donnie Day Patriarca says:

    I am a US citizen living in Nigeria with my husband who works for Shell. I will be 65 on Christmas Day 2010. So, in September I started trying to figure out how to apply for medicare online. And yes, of course, I know that I can only use it while in the US but I still need to apply. I finally learned that I needed to file in the US Consulate Office here in Lagos where we live. I went there in September and after a few hours learned that they had never had anyone come in to file and really didn’t know how to do it. They said they would send my information to their office in the UK and that office would call me. It is now nearing the end of October and I still haven’t heard anything. Can you please help me? Thanks, Donnie

  • Brenda Osborn says:

    i have trouble finding providers in my network in my area, many of which are 40=50 miles away and i don’t have a vehicle that i feel secure in taking on trips like that. I also have found that there is money up front that our providers require when our benefits plan tells us its just the office visit…
    very disappointing cause i need to see a foot doctor, a chiropractor (that doesnt charge $135 for the visit) and my mobility is getting worse all the time

  • george thomas says:

    I woullike a reply to my appeal for medicare denial of coverage of a nutritional supplement that has been covered for the past 11 years.

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