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.
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