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    Centers for Medicare & Medicaid Services (CMS)

    Also known as CMS, Centers for Medicare and Medicaid Services

    The Centers for Medicare & Medicaid Services (CMS) is the federal agency that provides health coverage to more than 160 million people through Medicare, Medicaid, the Children's Health Insurance Program and the Health Insurance Marketplace.[1] In 2026 it issued the Medicaid work requirement rule, negotiated Medicare drug prices and set 2027 Medicare drug benefit parameters. It is led by Administrator Mehmet Oz.[2][3][4][5]

    Editor reviewedStrict sourcingUpdated WikiHealth and medicine, Tech policy
    Key facts

    The Centers for Medicare & Medicaid Services (CMS) is the federal agency that runs Medicare and Medicaid, under the US Department of Health and Human Services.[5] It provides coverage to more than 160 million people through Medicare, Medicaid, the Children’s Health Insurance Program (CHIP) and the Health Insurance Marketplace.[1] CMS policy is politically contested, so this page attributes statements to the officials who made them.

    Programs and spending

    Medicare and Medicaid trace back to a law President Lyndon B. Johnson signed on 30 July 1965.[6] In 2024 Medicare spending was $1,118.0 billion, and US national health spending was $5.3 trillion, or 18.0% of GDP.[7] CMS’s actuaries project health spending will reach 20.6% of GDP by 2034.[8] For international context, US health consumption spending per person in 2024 was about twice the average of comparable wealthy countries.[9]

    Enrollment windows and scale

    CMS runs Medicare Open Enrollment, which for 2027 coverage is from 15 October to 7 December 2026.[10] It projects about 34 million Medicare Advantage enrollees in 2027, roughly 47.4% of everyone on Medicare.[11] On HealthCare.gov, the federal Marketplace site, Open Enrollment for 2027 runs from 1 November 2026 to 15 January 2027.[12] Thirty states use the federal Marketplace, while some others run their own.[13][14] Medicaid, which CMS oversees jointly with the states, cost $931.7 billion in 2024.[15][7]

    Leadership

    Mehmet Oz is the 17th CMS Administrator. He serves under HHS Secretary Robert F. Kennedy Jr. and President Donald Trump.[5] The agency is headquartered in Baltimore, Maryland.[16]

    Major decisions in 2026

    • Medicaid: On 1 June 2026, CMS issued the interim final rule that sets out how states must apply the 80-hour-a-month work requirement from 1 January 2027.[2]
    • Drug prices: CMS selected 15 drugs for the third negotiation cycle, including Part B drugs for the first time.[3] It runs the Negotiation Program.
    • Medicare 2027: CMS’s 2027 rate announcement set the standard Part D out-of-pocket threshold at $2,400, up from $2,100.[4] It is ending the Part D premium stabilization demonstration after 2026.[17] It projects lower average Medicare Advantage premiums in 2027.[11]
    • Marketplace: In September 2026, CMS said it was cancelling about 315,000 enrollments covering more than 760,000 people that it described as unauthorized. It also paused new agent and broker registrations for 2027.[18][19]

    Views on CMS actions

    Oz described the drug selection as part of an effort under President Trump to target Medicare’s most expensive drugs.[20] KFF said the Marketplace cancellation process likely removed some people who were enrolled legitimately.[21] For the wider picture, see the health care changes tracker, the Medicaid changes explainer and the Medicare 2027 explainer.

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    Questions readers ask

    What does CMS do?

    CMS provides health coverage to more than 160 million people through Medicare, Medicaid, the Children's Health Insurance Program and the Health Insurance Marketplace.[1]

    Who runs CMS?

    Mehmet Oz is the 17th Administrator of CMS, serving under HHS Secretary Robert F. Kennedy Jr.[5]

    Where is CMS based?

    CMS is headquartered at 7500 Security Boulevard in Baltimore, Maryland.[16]

    How much does the US spend on Medicare and Medicaid?

    In 2024 Medicare spending was $1,118.0 billion and Medicaid spending $931.7 billion, within total national health spending of $5.3 trillion.[7]

    Sources

    · 22 claims from 9 publishers

    Each numbered claim is a statement we checked against the sources listed with it. Tap a number in the text to see its sources in place.

    1. [1]

      CMS is the federal agency that provides health coverage to more than 160 million people through Medicare, Medicaid, the Children's Health Insurance Program and the Health Insurance Marketplace. confirmedas of 2026-10-11

      • About CMS · U.S. Centers for Medicare & Medicaid Services (retrieved 2026-10-11)
    2. [2]

      CMS issued an interim final rule on 1 June 2026 implementing the requirement of 80 hours a month of qualifying activity; states must generally implement it by 1 January 2027. confirmedas of 2026-06-01

    3. [3]

      On 27 January 2026 CMS selected 15 drugs for the third cycle, including the first Part B drugs, with prices effective 1 January 2028; the list is Anoro Ellipta, Biktarvy, Botox, Cimzia, Cosentyx, Entyvio, Erleada, Kisqali, Lenvima, Orencia, Rexulti, Trulicity, Verzenio, Xeljanz and Xolair, and Tradjenta was picked for renegotiation. confirmedas of 2026-01-27

    4. [4]

      Under the standard Part D benefit, the annual out-of-pocket threshold rises from $2,100 in 2026 to $2,400 in 2027, and the maximum deductible from $615 to $700. confirmedas of 2026-04-06

    5. [5]

      Mehmet Oz is the 17th Administrator of CMS, serving under HHS Secretary Robert F. Kennedy Jr. confirmedas of 2026-10-11

      • About CMS · U.S. Centers for Medicare & Medicaid Services (retrieved 2026-10-11)
    6. [6]

      President Lyndon B. Johnson signed the law that created Medicare and Medicaid on 30 July 1965. confirmedas of 2026-10-11

      • About CMS · U.S. Centers for Medicare & Medicaid Services (retrieved 2026-10-11)
    7. [7]

      US national health expenditure grew 7.2% to $5.3 trillion in 2024, or $15,474 per person and 18.0% of GDP; Medicare spending was $1,118.0 billion and Medicaid $931.7 billion. confirmedas of 2026-10-11

    8. [8]

      CMS actuaries project health spending will grow 5.4% a year on average over 2025-2034, faster than GDP, raising its share of GDP from 18.0% in 2024 to 20.6% in 2034. confirmedas of 2026-10-11· forecast

    9. [9]

      The OECD estimates the US spent $14,885 per person on health in 2024 (in purchasing-power terms), against an OECD average of $5,967, equal to 17.2% of GDP against an OECD average of 9.3%; compared only with comparably wealthy countries, Peterson-KFF finds US health consumption spending of $14,775 per person, about twice the peer average of $7,860. confirmedas of 2026-03-11

    10. [10]

      Medicare Open Enrollment for 2027 coverage runs from 15 October to 7 December 2026, and people who keep their current coverage generally do not need to re-enroll. confirmedas of 2026-09-28

    11. [11]

      CMS projects the weighted average monthly Medicare Advantage premium will fall from $14.37 in 2026 to $12.00 in 2027 (16.5%), with about 34 million enrollees, roughly 47.4% of Medicare. confirmedas of 2026-09-28· forecast

    12. [12]

      On HealthCare.gov, Open Enrollment for 2027 coverage starts 1 November 2026; enrolling by 15 December gives coverage from 1 January, and Open Enrollment ends 15 January, with coverage from 1 February for later sign-ups. confirmedas of 2026-10-11

    13. [13]

      The White House announced on 10 September 2026 one-time $500 refunds for nearly 1 million unsubsidized enrollees in the 30 states using the federal Marketplace, describing them as returning excess user fees; the Treasury began sending payments to more than 950,000 people around the start of October. confirmedas of 2026-10-02

    14. [14]

      Critics including the Center for American Progress said the $500 refunds do little against higher premiums, and KFF noted they exclude subsidized enrollees and those in states running their own Marketplaces. confirmedas of 2026-10-06

    15. [15]

      Medicaid is a joint federal and state program that provides free or low-cost coverage to some low-income people, families, children, pregnant women, older adults and people with disabilities. confirmedas of 2026-10-11

    16. [16]

      CMS is headquartered at 7500 Security Boulevard, Baltimore, Maryland. confirmedas of 2026-10-11

    17. [17]

      CMS is ending the voluntary Part D Premium Stabilization Demonstration at the end of 2026; the 2027 base beneficiary premium is $41.33. confirmedas of 2026-07-28

    18. [18]

      On 22 September 2026 CMS said it was cancelling about 315,000 unauthorized federal Marketplace enrollments covering more than 760,000 people, expecting to recover about $2.2 billion in subsidies. confirmedas of 2026-09-22

    19. [19]

      CMS issued an interim final rule pausing new registration for the 2027 plan year for agents and brokers without an active 2026 Exchange agreement, and is requiring brokers to re-verify identity and to get electronic consumer authorization. confirmedas of 2026-09-22

    20. [20]

      CMS Administrator Mehmet Oz said that under President Trump CMS is targeting the most expensive drugs in Medicare and negotiating fair prices. confirmedas of 2026-01-27

    21. [21]

      KFF and other critics said the cancellation process, applied to flagged enrollees who did not respond to outreach within 30 days, likely removed some legitimately enrolled consumers. reportedas of 2026-10-06· interpretation

    22. [22]

      Under the Negotiation Program CMS directly negotiates prices of certain high-expenditure, single-source drugs without generic or biosimilar competition; on 13 March 2026 it announced that the manufacturers of all 15 third-cycle drugs, and of the drug selected for renegotiation, chose to participate. confirmedas of 2026-03-13

    Revision history (1)
    1. Page created.

    Created Oct 11, 2026. Last reviewed by an editor on Oct 11, 2026. Next scheduled review: Jan 11, 2027.

    Cite this page

    "Centers for Medicare & Medicaid Services (CMS)." ContentLora, updated Oct 11, 2026. https://contentlora.com/wiki/centers-for-medicare-and-medicaid-services

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