The Centers for Medicare & Medicaid Services, also known as CMS, is a part of the U.S. Department of Health and Human Services (HHS), an agency of the federal government. The CMS and what it does can be extensive topics to explore. To help makes things simple, we’ve provided some highlights about CMS’s Medicare and Medicaid Services.

What are the Centers for Medicare & Medicaid Services?

The CMS creates policies, regulates health standards, and performs quality control measures for the Medicare and Medicaid programs. This includes overseeing certification programs and information reporting for Medicare providers and investigating complaints that involve fraud, waste, and abuse. CMS carries out many of its responsibilities in conjunction with other government agencies, such as the Social Security Administration and the Office of the Inspector General.

CMS & Medicare Coverage

The Centers for Medicare & Medicaid Services administers the Original Medicare program, which provides Part A hospital insurance and Part B medical insurance. You may know Medicare as the insurance you get when you turn 65. But keep in mind that Medicare is not “free.” You pay for it throughout your working years, usually through payroll taxes that go to Social Security or the Railroad Retirement Board RRB). Here are some highlights about the CMS Medicare insurance program::

  • You’re eligible for Medicare when you turn 65, or if you’re under 65 and have a disability or qualifying medical condition, such as End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS).
  • Part A helps cover services, including inpatient hospital, skilled nursing facility, and hospice care. Part B helps pay for outpatient and preventive medical care, physician services, and durable medical equipment.
  • You may be automatically enrolled in Part A, but you’ll probably have to actively enroll in Part B. You may pay a late enrollment penalty if you don’t enroll when you’re first eligible during your Part B Initial Enrollment Period.
  • Medicare Part A usually doesn’t have a monthly premium if you’ve paid Medicare taxes for at least 10 years. But Part B includes a premium that may be deducted from your Social Security, RRB, or Office of Personnel Management benefits.

Read this article to learn more about the Medicare program.

Other Medicare Parts (Part C and Part D)

You may have heard of Medicare Part C, also known as Medicare Advantage, and Medicare Part D for prescription drug coverage. Both Part C and Part D plans are sold and administered through private insurance companies that contract with Medicare. Let’s go over a few things you should know about these plans.

  • Medicare Advantage (MA) plans provide an alternative way to get Parts A and B benefits.
  • Most MA plans include prescription drug benefits, and some provide other health benefits, such as dental, vision, hearing, and fitness coverage.
  • Along with your Part B premium, you may pay a monthly premium for your MA plan. Although, there are MA plans available that have a $0 monthly premium.
  • You don’t get Part D prescription drug coverage automatically when you enroll in Medicare. You can add a Part D drug plan to Original Medicare, or you can enroll in an MA plan that includes drug coverage.
  • If you get Parts A and B benefits through an MA plan or are enrolled in a Part D plan, your claims and premium payments will be coordinated through the insurance company. But the Part A, Part B, and Part D programs are still regulated by the Centers for Medicare & Medicaid Services (CMS), so insurance companies must follow CMS’s rules. 

CMS & Medicaid Coverage

Medicaid is available to low-income people, including children, the elderly, and disabled individuals. The program is funded by states and the federal government. States administer its own Medicaid programs, but must follow federal regulations from the Centers for Medicare & Medicaid Services. Below are some more highlights about the CMS Medicaid program:

  • You qualify for Medicaid if you have been receiving Supplemental Social Security Income (SSI) for at least one month.
  • Your Medicaid eligibility starts the same month as your SSI eligibility.
  • Eligible children can get health insurance through Medicaid and separate state-run programs provided through the Children’s Health Insurance Program (CHIP).
  • Some people are eligible for coverage through both Medicare and Medicaid, called dual eligibility.

Medicare Insurance That Is NOT Regulated By CMS

There is another type of Medicare insurance called Medicare Supplement or Medigap. This insurance product is designed to help pay for your Original Medicare out-of-pocket expenses, such as coinsurance, copays, and deductibles. Plans must follow federal and state laws. However, Medicare Supplement plans are regulated by states, not CMS. Here are some more details:

  • The majority of states have 10 standardized plans, which are represented by letters (A, B, C, D, F, G, K, L, M, and N). There is also a high-deductible version of Medicare Supplement Plan F.
  • Plans C and F are only available to those who were eligible for Medicare prior to January 1, 2020.
  • Medigap is regulated differently in Massachusetts, Minnesota, and Wisconsin.
  • Plans are only available through private insurance companies. But insurance companies aren’t required to sell all plans.
  • You can buy any Medicare Supplement plan that’s available in your area regardless of any health problems you may have during your Medigap open enrollment period.
  • You must have both Medicare Parts A and B to buy a Medigap plan.
  • You can’t have Medigap and Medicare Advantage at the same time.

How To Choose Your Medicare Coverage

If you’re interested in exploring your Medicare options, HealthMarkets can help you find coverage.

You can compare plans online, or a licensed insurance agent can help you compare Medicare Advantage plans that use your preferred healthcare providers, review Part D plans to find affordable drug coverage for your prescriptions, and check which Medigap plan option is right for you. Contact us today at (800) 439-6916, or meet with an agent in your area to get help choosing the right Medicare plan, at no cost to you. 


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