The Centers for Medicare and Medicaid Services manages programs that affect more than 100 million Americans. It has a national scope and involves every level of government engaged in healthcare across the US.
The below-listed items describe the major health care programs of the CMS:
Medicare is the national health insurance system for senior citizens. It accepts persons at age 65 or earlier if disabled. Medicare provides Hospital care (Part A) medical insurance (Part B), prescription drug insurance (Part D).
The Original Medicare consists of Part A and Part B.Medicare Part C is the private provider system for medical insurance, hospitalization insurance, and prescription drug coverage.
The below-listed combinations provide health, hospital, and medical coverage for senior citizens.
Original Medicare Part A and Part B provides coverage for medical insurance and hospital care.
Medicare Advantage is Medicare Part C; it includes the hospital and medical insurance of Original Medicare, but from private insurers. Many Medicare Advantage plans include prescription drug options.
Medicare Part D is standalone prescription drug coverage that goes with Medicare Part A and Part B to provide comprehensive insurance protection for senior subscribers.
Medicaid is the national program of medical insurance for low-income Americans. The states administer the program with federal aid.
States set the income limits for qualifying applicants. The range is substantial as some states limit it to about one-half of the federal poverty line.
Medicaid is full insurance coverage for the purposes of the Affordable Care Act and the individual mandate.
It has the minimum value required by law, and the essential health benefits. The incomes between the marketplace minimum and the Medicaid maximum is the Medicaid Gap. It left millions of Americans without insurance or the means to get it.
Based on need the CHIP accepts qualified applicants on a year-round basis with no closed enrollment season.
The program accepts pregnant women and provides prenatal care and insurance coverage.
Health Insurance Marketplace
The Health Insurance Marketplace consists of the federal marketplace at healthcare.gov and the seventeen state-run insurance exchanges. This is the Internet-based system for health insurance under the Affordable Care Act.
The consumer can visit the Health Insurance Marketplace to purchase insurance during the open enrollment period.
The policies sold in the Health Insurance Marketplace meet or exceed the requirements of the individual mandate. Consumers not only avoid the penalty, but they also get valuable coverage and the essential health benefits.
The Affordable Care Act implementation added a long list of prevention and wellness services and mental health services to the standard terms of Medicare.
It also made changes that help reduce the coverage gap for prescription drugs, the so-called Donut Hole. The ACA will reduce the Donut Hole each year until 2020 when it should no longer exist.
CMS provides grants and contracts to promote needed research and innovation. These efforts help improve the nation’s healthcare delivery systems and raise the quality of healthcare.
Change and managing change are vital parts of the rapidly developing healthcare industry.
Greater demand drives it due to increased insurance coverage. The steady stream of new drugs, technologies, and medical discoveries also drives change.
Strengthening Health Systems and Institutions
The CMS has programs to study the changing health needs of the diverse American population. It uses incentives to reduce hospital readmissions, hospital errors, and hospital-borne infections.
CMS promotes quality medical care and carefully monitors compensation for medical services providers.
Medical and Health Information Technology
The emerging fields of medical research, gene-based therapies, and advances in cellular immunology challenge the entire medical system.
Medical Information Technology is a growing and vital concern of the CMS. It must protect the integrity of information including intellectual property. It must protect medical information and client files that contain sensitive and personal information.
HIPPA standards require elaborate security measures and payment and administrative systems.
The overall goal is health and medical treatment that sometimes means the difference in survival outcomes.
The CMS is an Important Federal Agency
The CMS manages and oversees a remarkable national healthcare system. It works with states and the private sector to deliver medical care, hospitalization, prescription drugs, and medical equipment to more than 100 million people.
Built in layers over a long course of years, Medicare systems provide the solid and reliable foundation for caring for an aging US population.
When considering prescription drug plans and major medical insurance under Part C, the consumer can take advantage of comparison shopping to find the best fit for their circumstances.
The systems permit access to drug formularies to check the precise drug and dosage used by the applicant.
Adding comparison shopping one can focus on expected future needs such as planned medical procedures.