The United States Centers for Medicare and Medicaid Services (CMS) is a federal agency within the Department of Health and Human Services (HHS) that administers and oversees two major government healthcare programs, namely Medicare and Medicaid. These programs provide health insurance coverage to specific groups of individuals, such as the elderly, disabled, low-income individuals, and certain others.
Medicare is a federal health insurance program primarily available to individuals aged 65 or older, as well as certain younger individuals with disabilities. It covers a variety of medical services and healthcare costs, including hospital stays, doctor visits, prescription medications, and some preventive services.
Medicaid, on the other hand, is a joint federal-state program that provides healthcare coverage to low-income individuals, including pregnant women, children, families, and individuals with disabilities. Unlike Medicare, Medicaid eligibility and benefits can vary by state, as each state has the flexibility to design and implement its own program within federal guidelines.
The CMS plays a vital role in overseeing and monitoring the implementation of Medicare and Medicaid, ensuring that eligible individuals receive appropriate healthcare services. It establishes regulations, develops payment systems, and conducts audits and quality assessments to ensure compliance and proper utilization of healthcare resources. The agency also coordinates with state Medicaid agencies, private insurance companies, healthcare providers, and beneficiaries to improve the delivery and quality of healthcare services to vulnerable populations across the United States.
