The US government is blocking health insurance companies from practicing “seamless conversion” – a controversial practice where customers who become eligible for Medicare are moved to Medicare Advantage plans automatically.
Officials are currently reviewing the process. They will soon issue new guidelines for plans that are already allowed to make these shifts, says a memo from Michael Crochunis, acting director of the Medicare Enrollment and Appeals Group at the Centers for Medicare and Medicaid Services (CMS).
The current rules state that insurance companies can transfer customers who have policies bought through an Affordable Care Act insurance exchange or other plans when they become qualified for Medicare, usually at the age of 65.
The insurer issues a 60-day written notice, and if they don’t receive an opt-out from the customer, they make the enrollment automatically.
But many senior citizens and advocates argue that such notices are easily lost in the overflow of letters from insurance companies trying to get seniors to join Medicare Advantage plans, The Washington Post reports.
Medicare Advantage plans are private policies that take the place of traditional, government-covered Medicare. They limit customers to specific providers. It’s a voluntary program for most seniors, and around a third of older or other-abled Americans who are eligible for Medicare opt out of it. The Advantage plans include additional services like eye and dental care, or things like gym membership discounts.
Kaiser Health News and The Washington Post identified some problems with the seamless conversion in July, prompting the temporary pause on Medicare Advantage transitions. Some seniors had no idea they already had a different plan in place until they received thousands of dollars in bills from health care providers outside the network. Others suddenly received Medicare Advantage membership cards they hadn’t requested, along with names of doctors they didn’t know.
A CMS spokesperson encourages seniors to open all their mail from their insurance companies, even if they chose traditional Medicare, so they can review all their options.
There are 29 insurance companies across 16 states allowed to perform seamless conversion, according to CMS. Close to half of them got approval earlier this year, and the spokesperson for CMS said they are working with the companies to check on how many customers were enrolled using this process.
Advocacy groups asked Andy Slavitt, acting administrator for CMS, to look into better customer protection. They argue that seniors should be able to leave their plan any anytime and join Medicare, or choose other plans they feel is best for them.
The American Medical Association has also asked Slavitt to oversee changes in the program. Medicare Advantage networks are more restricted, so seniors can lose their doctors when insurers transfer them to new plans, according to AMA’s chief executive James Madara.
Madara said, “Clearly, when a patient’s non-Medicare insurance has been covering their care from a particular physician(s) and this physician(s) is not in the MA plan’s network, the result is far from seamless.”
