About to Turn 65? Your Health Insurer May Be Automatically Enrolling You in Its Own Medicare Plan

As people approach age 65- they should be thinking about their Medicare enrollment choices- including whether to sign up for traditional Medicare or with a Medicare Advantage plan- and if so- which one.  But it turns out that some Medicare-age people are having these important decisions made for them- often without their knowledge.

Before they become eligible for Medicare- many Americans are covered by a commercial or a Medicaid health care plan run by an insurance company. These insurers often also operate Medicare Advantage plans- which are the privately run managed-care alternative to traditional Medicare. Under a little-known process authorized by the federal government- insurers can shift their beneficiaries who are turning 65 to their own Medicare Advantage plan.  It’s called “seamless conversion-” and all it requires is that the health plan obtain Medicare’s prior approval and send a letter to the beneficiary explaining the new coverage- which takes effect unless the member opts out within 60 days.

The idea is to preserve continuity for those who want to stay with the same company- but some seniors are unaware that they have been signed up- in part due to the flood of mail they get from insurers around age 65.  In a recent Kaiser Health News expose– reporter Susan Jaffe related the stories of several new Medicare beneficiaries who were shocked to learn that they had been enrolled in a Medicare Advantage plan.  One- Judy Hanttula of Carlsbad- New Mexicio- signed up for traditional Medicare and then ignored the subsequent mail- which apparently included the notice from her insurer telling her that it had automatically enrolled her in its Medicare Advantage plan.

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

Unfortunately for Ms. Hanttula- before she became aware of the automatic assignment to a Medicare Advantage plan- she had surgery that her new plan subsequently refused to cover- leaving her with a $16-622 bill.  Eventually- with the help of David Lipschutz- a senior attorney at the Center for Medicare Advocacy in Washington- Medicare officials disenrolled Ms. Hanttula from her unwanted Medicare Advantage plan- restored her traditional Medicare coverage and agreed to cover her medical bills- reports Jaffe.

Medicare officials won’t say which insurance companies have sought or received approval to seamlessly convert their members to their own Medicare Advantage plans- but Jaffe reports that among the insurers that are already automatically enrolling members into Medicare plans in at least some parts of the country include Aetna and United Healthcare- and that Humana- the nation’s second largest Medicare Advantage provider- has asked for federal permission to also do auto-enrollment.

Medicare officials are developing procedures for seamless conversion requests and implementation- but in response to complaints from her contituents and health care advocates- Rep. Jan Schakowsky (D-Ill.) wants to build in stronger consumer protections.

In the meantime- those enrolled in a health plan offered by a Medicare Advantage organization when they become eligible for Medicare should “be attentive-” advises attorney Lipschutz of the Center for Medicare Advocacy.  “Be on the lookout for written notice regarding conversion and carefully consider whether to opt-out of the [Medicare Advantage] plan.”