Medicare Advantage Auto Enrollment

If you are turning 65 and transferring from an individual health plan to Medicare, BEWARE!  You might find yourself the victim of Medicare Advantage auto enrollment.

I just read an article in Kaiser Health News that says:

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.

Medicare officials refused recently to name the companies that have sought or received such approval or even to say how long the Centers for Medicare & Medicaid Services has allowed the practice. Numerous insurers, including Cigna, Anthem and other Blue Cross Blue Shield subsidiaries, also declined to discuss whether they are automatically enrolling beneficiaries as they turn 65.

Here is one person’s experience with Medicare Advantage auto enrollment :

Sally Thomphsen, who lives outside Chicago and had an individual health policy from Blue Cross Blue Shield last year, was more than surprised when she received her member card for a Medicare Advantage plan shortly before turning 65. Printed on the card was the name of her new primary care physician, someone she didn’t know.

“I almost hit the ceiling,” said Thomphsen, who had already enrolled in traditional Medicare.

Holy cow!  Some insurance industry lobbyist must have used their influence to get this approved.  It is a slick way to increase the number of Medicare beneficiaries who are enrolled in private Medicare plans known as “Medicare Advantage”.  These people leave “Original Medicare” and essentially subcontract their Medicare to a private insurance company.

As an insurance broker, I sell both Medicare supplements AND Medicare Advantage plans – but I always explain both types of coverage to my clients.  I explain how Medicare supplements fill the gaps in Original Medicare.  I also explain how Medicare Advantage plans work.  Then I let the client decide which type of coverage he thinks would work best for him. But I generally spend one or two hours discussing the pros and cons of both types of coverage and answering lots of questions from my client.

Medicare Advantage auto enrollment means a person turning 65 does not get the opportunity to investigate all his Medicare coverage options. It also does not make people aware of some of the rules associated with Medicare Advantage, such as:  staying in network; getting referrals; getting prior authorization for certain tests and procedures.

And I don’t suppose people are told that once they have been in a  Medicare Advantage plan for a year, they might not be able to get a Medicare supplement if they return to Original Medicare in the future. There are rules and requirements for Medicare supplements and I always explain them to my clients.

I just find it unbelievable that Medicare would allow Medicare Advantage auto enrollment. This is so bad for so many reasons.

The Kaiser Health News article can be read in full here: Some Seniors Surprised to be Automatically Enrolled in Medicare Advantage Plans.

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