Dive Brief:
- The CMS has announced an internal review of its policy in which it approves insurers to automatically enroll their commercial or Medicaid customers into their Medicare Advantage plans as they become eligible, Modern Healthcare reported.
- The policy, which only gained attention this past summer after a Kaiser Health News report, has raised some controversy for taking enrollees by surprise, and for CMS' previous lack of disclosure for which MA plan issuers were approved to use "seamless conversion," which it has now just released.
- Due to inquiries over the use of the policy and concerns for the protection of beneficiaries, CMS now says it will temporarily stop approving any more MA plans from using the process and will issue a policy clarification to the 29 issuers that already have approval.
Dive Insight:
The automatic "seamless conversion" process has been criticized for being opaque and confusing to seniors, many of whom have already enrolled in traditional Medicare, and then become enrolled in Medicare Advantage plans without their knowledge or approval, receiving only notification and an opt-out window of 60 days –assuming they actually receive, read and understand that piece of mail, and don't assume it to be a marketing item because it comes from a plan they never contacted.
Opponents have argued such correspondence is insufficient and that opt-in would be more appropriate, noting unlike Medicare, MA plans have narrow networks, leading to unexpected out-of-network charges for those enrollees who thought they were on traditional Medicare or didn't understand their MA plan limitations.
Providers have also chimed in on the issue, Modern Healthcare previously reported, arguing while the process is ostensibly aimed at seamless insurance coverage, it is only seamless to insurers' ability to maintain their member base, while it is actually disruptive to enrollees' continuity of care because of the push into a new narrow network.
The 29 companies currently approved to use the process include Aetna, UnitedHealth and a number of Blues plans, according to the new data disclosed by CMS.