Surprise! Some New Medicare Beneficiaries Enrolled in Private Managed Care Plans Without Their Knowledge

Kaiser Health News reported this week that Medicare has given some Medicare Advantage plans permission to automatically enroll their health plan members into their Medicare managed care plan when they turn 65 – and that many beneficiaries are not aware this change has happened.  This “seamless conversion” allows companies to keep members of their plans they might have had with their employers or if they were in the company’s Medicaid plan.  The companies are required by Medicare to send a notice 60 days before the person joins Medicare.  However, some beneficiaries didn’t read or understand the letter or in some cases ignored it, thinking they were going to be enrolled in traditional fee for service Medicare when they turned 65.

This conversion can have serious consequences as one beneficiary learned because the Medicare Advantage plan had different terms and participating providers than her previous plan.  Kaiser reported her situation:

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.

This report is causing alarm bells with many beneficiaries and advocates who were unaware Medicare allows this and many other Medicare Advantage private companies are seeking permission for this “seamless conversion.”    Congresswoman Jan Schakowsky, an Illinois Democrat, is already considering legislation that would require beneficiaries to opt-in to this conversion rather than have to opt-out.

The Medicare Advantage plans have been arguing that this conversion allows persons to stay with their same company as they turn 65.  What they are not saying though is that the Medicare plan they offer is different than the plan the beneficiarey previously had and it can cost beneficiaries thousands if the providers they used are not part of the Medicare Advantage plan.

 

Published by

gny53

I have been a senior advocate for most of my career. I was Executive Director of the New York StateWide Senior Action Council and the New York State Alliance for Retired Americans. In 2007-2010 I was the Director of the New York State Office for the Aging

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