Medicare Your Coverage Options

Turning 65? Make sure you’re not involuntary enrolled in a Medicare Advantage plan

Written by Diane Archer

An increasing number of people first going on Medicare are being involuntarily enrolled in Medicare Advantage plans when they turn 65. The Centers for Medicare and Medicaid Services, CMS, has given their health insurers the right to enroll them in the insurers’ Medicare Advantage plans–commercial insurance plans that offer Medicare benefits under special conditions–without their permission. If you’re turning 65, make sure you’re not involuntary enrolled in a Medicare Advantage plan.

To date, CMS already has approved proposals from 27 insurance companies to “seamlessly enroll” their Medicaid and commercial members in their Medicare Advantage plans once they become eligible for Medicare. Aetna, UnitedHealth Group, Health First, Anthem and Blue Cross Blue Shield of Michigan are among the companies with permission. For the full list, click here.

These insurers have permission from CMS to enroll their members who become eligible for Medicare in their Medicare Advantage plans without signed authorization from their members. These enrollments should be described as “troubling,” not “seamless.” The insurers’ Medicare Advantage plans generally have different doctor and hospital networks and different cost structures from the pre-Medicare health plans they offer members.

This automatic and troubling Medicare Advantage enrollment undermines people’s choice and jeopardizes their continuity of care, leaving them at significant financial and health risk. Indeed, traditional Medicare is the only choice that maximizes the likelihood of that continuity of care.

People who turn 65 should be able to assume they are enrolled in traditional Medicare, which has been the case. Historically, people who don’t affirmatively choose to enroll in a Medicare Advantage plan by signing up with one are enrolled in traditional Medicare. If they are enrolled in a Medicare Advantage plan without their knowledge, it can wreak havoc on their lives.

When people believe they are enrolled in traditional Medicare–and they are not–they will use whichever doctors and hospitals they please. Since these providers are likely not in the Medicare Advantage plan’s network into which they have been involuntarily enrolled, they can get hit with huge out-of-network charges.

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. CMS relies on the insurers to notify their members. But, people may not read mail from their insurers once they’ve signed up for Medicare. Instead, they may assume they are enrolled in traditional Medicare, seek care, and rack up huge costs 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.

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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  • Several years ago, most Medicare-eligible members of the Commonwealth PA Retirees’ health plan were involuntarily enrolled in Medicare Advantage plans. The Commonwealth went to great lengths to hide this from retirees, making it sound like this was just a change to a new provider. Many, if not most retirees, have no idea that they are in a Medicare Advantage plan, and many have no idea what the difference is anyway. They use terms like “medical plan choices” and “generous benefits” to hide the fact that they hijacked the retirees’ traditional Medicare and handed it to greedy, private, for-profit insurance companies, which costs retirees their choice of providers and imposes co-pays and other conditions not found in Traditional Medicare. I understand this was possible because the law provides for waivers of the provision that enrollment in Medicare Advantage must be voluntary. Involuntary enrollment in Medicare Advantage is fraud and must stop. We need to get for-profit, private insurance companies out of health care—starting with Medicare!

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