Tag: seamless conversion

Medicare Bars New ‘Seamless Conversion’ Efforts For Some Seniors

By Susan Jaffe  | Kaiser Health News | October 28, 2016 |  This KHN story also ran in 

The federal government is temporarily blocking more health insurance companies from automatically moving customers who become eligible for Medicare into Medicare Advantage plans while officials review the controversial practice.

They also will issue rules soon for plans that already have permission to make these switches, known as “seamless conversion,” according to a memo from Michael Crochunis, acting director of the Medicare Enrollment and Appeals Group at the Centers for Medicare & Medicaid Services.

Under current rules, an insurer can transfer customers who have purchased policies through an Affordable Care Act insurance exchange or other commercial plans when they become eligible for Medicare, typically at age 65. An insurer must give an individual 60 days’ advance written notice of the switch; if a person doesn’t opt out, that enrollment takes effect automatically.

… The decision to prohibit additional insurers from pursuing Medicare Advantage conversions comes after Kaiser Health News and The Washington Post identified problems with the practice in July. Some seniors did not know they had different coverage until receiving out-of-network providers’ bills for thousands of dollars. Others got the news when they received a Medicare Advantage membership card they hadn’t requested — with the name of a new primary care doctor they didn’t know. [Continued in Kaiser Health News and The Washington Post]…

Some Seniors Surprised To Be Automatically Enrolled In Medicare Advantage Plans

By Susan Jaffe  | Kaiser Health News | July 27, 2016 |  This KHN story also ran in 

Only days after Judy Hanttula came home from the hospital after surgery last November, her doctor’s office called with bad news: Records showed that instead of traditional Medicare, she had a private Medicare Advantage plan, and her doctor and hospital were not in its network.

Neither the plan nor Medicare now would cover her medical costs. She owed $16,622.

“I was panicking,” said Hanttula, who lived in Carlsbad, N.M., at the time. After more than five hours making phone calls, she learned that because she’d had individual coverage through Blue Cross Blue Shield when she became eligible for Medicare, the company automatically signed her up for its own Medicare Advantage plan after notifying her in a letter. Hanttula said she ignored all mail from insurers because she had chosen traditional Medicare.

“I felt like I had insured myself properly with Medicare,” she said. “So I quit paying attention to the mail.”

With Medicare’s specific approval, a health insurance company can enroll a member of its marketplace or other commercial plan into its Medicare Advantage coverage when that individual becomes eligible for Medicare. Called “seamless conversion,” the process requires the insurer to send a letter explaining the new coverage, which takes effect unless the member opts out within 60 days. [Continued in The Washington Post and Kaiser Health News]…