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Is involuntary enrollment in Medicare Advantage plans the new norm?

Written by Diane Archer

It has been the norm that when people first go on Medicare, they are automatically enrolled into traditional Medicare unless they affirmatively choose a Medicare Advantage plan. In recent years, however, involuntary enrollment in Medicare Advantage plans has become the new norm for a small but growing number of people.  Automatic Medicare Advantage enrollment undermines people’s choice, placing millions of people with Medicare at significant financial and health risk.

Susan Jaffe reports for Kaiser Health News that, when you first become eligible for Medicare, your health plan, under some circumstances, has the right to automatically enroll you in its Medicare plan (a commercial health plan like Aetna or Human that typically only covers care from doctors and hospitals in its network).  Here’s how it appears to work.

Under this “seamless conversion” policy, health insurers have access to data that lets them know when their members enroll in Medicare. At that time, so long as  the Centers for Medicare and Medicaid Services (CMS) approves, they have the  right to move their members from a state health exchange plan or other health plan into their Medicare Advantage plan.

However, CMS does not notify the people who are involuntarily enrolled in their health plans’ Medicare Advantage plans that they are no longer in traditional Medicare. It relies on the insurers to notify their members. Of course, people may not read their mail, particularly mail from insurers they thought they were moving on from once they enrolled in Medicare. As a result, they may assume they are enrolled in traditional Medicare, seek care, and end up racking up tons of bills from out-of-network providers.

By allowing the insurers to automatically involuntarily enroll people in their Medicare Advantage plans, CMS is working against the interests of people with Medicare; it is disregarding its own advice to people choosing a Medicare plan to compare their options carefully. People are only protected if they receive and read the required health plan notification informing them of their automatic enrollment and their right to opt out within 60 days.

Insurers’ Medicare plans may have networks different from the networks available to their members pre-Medicare eligibility. They are also likely to have very different copays and deductibles. And, they are likely not to be a smart choice for people who want to continue to see the doctors they know and trust. Indeed, traditional Medicare is the only choice that maximizes the likelihood of that continuity of care.

Shockingly and inexplicably, CMS was not willing to tell Jaffe, the reporter, how long this practice has been in effect or which insurers had approval to use this “seamless conversion” process. As disturbingly, neither Cigna, Anthem or Blue Cross would tell Jaffe whether they were automatically enrolling people in their commercial Medicare plans.

Jaffe learned that Aetna is about to launch the process in parts of Florida. Humana and United Healthcare said that they plan to automatically enroll people as well.

Congresswoman Jan Schakowsky is looking into the possibility of an “opt-in” for people, rather than an opt-out, so that people consciously enroll in a Medicare Advantage plan only if that’s what they want to do. Until that happens, CMS could protect people if it automatically disenrolled them from a Medicare Advantage plan if they sign up for a Medicare supplemental policy. Since only people with traditional Medicare need such a policy, enrollment in a supplemental policy is a good indicator that they do not want to be enrolled in a Medicare Advantage plan.

Enrollment in a Medicare Advantage plan must be voluntary. So, if you or anyone you know is enrolled in Medicare Advantage plan involuntarily and unknowingly racks up bills from out-of-network doctors and hospitals, call your local State Health Insurance Assistance Program or SHIP for assistance disenrolling.

Here’s more from Just Care:

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6 Comments

  • Several years ago, my PCP’s association “encouraged” me to sign on with their Medicare Advantage plan. It was a disaster – most of my speciality physicians did not accept it, they claimed doctors who had never agreed to be on the plan, they didn’t cover tests and procedures that my doctors wanted, some specialties weren’t covered at all, I had to get their permission to see another doctor or get a second opinion, I ended up paying much higher co-pays than they advertised, payment was slow and took repeated calls to get processed. The only promise they delivered on was extremely low prescription co-pays. In short, if you’re never sick and don’t have any health problems go for it. Otherwise, a traditional plan will be much better.

  • My former employer hijacked my traditional Medicare and enrolled me in a Medicare Advantage plan without my consent because, unfortunately, Medicare Advantage is the only type health insurance the employer offers to retirees. The coverage is lousy and providers are restricted, but apparently it is cheaper for the employer. As far as I can tell, this is legal. I had a horrible and frustrating time even getting politicians who voted on this law to understand the issue. This needs to change. The Medicare Advantage program needs to end entirely! Write to Congress and demand that Medicare, Part C, be rescinded!

    • How do we enforce our laws as citizens?

      Leaders tell us we have ‘avenues’ of action but in reality we have no redress – which is totally and absolutely illegal on their part.

      Laws are being broken where the ACA is concerned and it’s not the only law that is being laid on Americans that IS illegal.

  • This happened to me and I am outraged by it! No one at any governmental agency would even admit to it, whether state or federal. I ignored all of the mail from the private insurance agency because I thought it was just marketing junk and I did not want that insurance, only traditional Medicare. I was horrified to find out months later that I was automatically enrolled into their plan that I was never even qualified to be in, in the first place! This turned out to be a total disaster for me and caused me much stress and time. It took me many months and dozens of hours to get this straightened out. When I finally got into traditional Medicare a full six months after I was first eligible for Medicare, I received a survey from CMS in the mail asking why I changed out of that Medicare Advantage plan. Well, I absolutely blasted them in writing when responding. I showed my outrage very plainly and wrote many extra notes, especially saying what an invasion of a patient’s rights and privacy this is, and it should be illegal. When the survey asked me if I would allow a followup by CMS to me in response to my answers, I said, yes, please, I would love to elaborate more and object personally. Please contact me. But of course, they never did. Now I am left with permanent mistrust of CMS and Medicare. This has been an extremely negative experience for me, and I am still trying to recover from it. To newly eligible Medicare recipients: BEWARE!!

  • …just one more way for the private insurance industry to profit off those who cannot afford it. To effectively “hijack” a person’s Medicare plan is just wrong and should be illegal. Considering that one presidential candidate has benefited from big money and corporate interests, and the other is a narcissistic racist xenophobe, I sadly don’t see this changing.

    We had one chance for true positive progressive change, but blew it.

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