Dive Brief:
- A process known as “seamless conversion” is raising eyebrows as multiple complaints have come forward from seniors enrolled in Medicare Advantage plans without their knowledge or approval, Kaiser Health News reports.
- As long as a health insurer receives specific approval from Medicare, it can enroll a member into a Medicare Advantage plan once that individual becomes eligible for Medicare.
- The insurer is only required to mail the member a letter about the new coverage, and can put it into effect unless the member opts out within 60 days.
Dive Insight:
At issue is whether a mailed letter provides sufficient notice or consumer protection, opponents of the practice argue. Some seniors have been caught off guard because they had already enrolled in traditional Medicare and assumed any correspondence from insurers to be marketing materials, causing at least one, who spoke to KHN, to miss the opportunity to opt out and get stuck with a $16,622 out-of-network hospital bill to resolve.
CMS and some insurers are remaining mum on the process, with Medicare officials refusing to tell KHN how long the practice has been allowed and what insurers have used it.
Officials are working on a review process for seamless conversion requests, and since a marketplace plan cannot drop a person for becoming eligible for Medicare, both plans would be active until the member cancels the marketplace plan.
Those insurers who are discussing it include Aetna, UnitedHealthcare, and Humana. Aetna noted it goes further than the requirements by giving members 90 days to opt out, providing a post card to do so, and following up with a phone call.
Illinois Rep. Jan Schakowsky is exploring legislation that would require an "opt-in" rather than an "opt-out" to allow seniors to make their own choice.
“The right to opt out doesn’t exist if they didn’t get the notice or if they did get the notice but didn’t understand it," David Lipschutz of the Center for Medicare Advocacy in Washington told KHN.