(The writer is a Reuters columnist. The opinions expressed are
By Mark Miller
CHICAGO, Sept 15 The Medicare enrollment process
is fraught with complicated choices - but one big decision could
be made for you automatically by a health insurance company if
you are not on your toes.
A little known rule allows some health insurance companies
to automatically sign people up for Medicare Advantage plans -
the managed care alternative to traditional Medicare. Under
so-called seamless conversion, an insurer can seek permission
from the Centers for Medicare & Medicaid (CMS) to auto-enroll
members of its non-Medicare insurance plans when they reach 65,
the age of Medicare eligibility.
Auto-enrollment might be convenient, but it short circuits
one of the most important choices to be made when signing up for
Medicare - whether to go with traditional fee-for-service
Medicare, or an Advantage plan.
Advantage plans offer some cost saving and usually include
prescription drug coverage. But the majority of Medicare
enrollees use traditional Medicare. And thorough shopping for an
Advantage plan requires a careful review of the networks of
health providers and prescription drug coverage to make sure
they are the best fit for an individual's health needs.
Congress gave the green light for seamless conversion
enrollment in 1997, and CMS established rules to allow them in
2005. Health insurance companies can seek permission to carry
out seamless conversions of members of their individual, public
exchange or Medicaid managed care plans.
Medicare has not released information on the prevalence of
seamless conversion. But the practice is drawing scrutiny from
consumer advocate groups, who are pushing for more transparency
from CMS on the companies and locations where the process has
"It flew under the radar for quite a long time, and it's
just beginning to gain more attention," said Gretchen Jacobson,
associate director of the program on Medicare Policy at the
Kaiser Family Foundation.
A Medicare spokesman said data will be released later this
year indicating which insurance companies are doing seamless
conversion, and where. CMS also is "refining" its procedures for
processing seamless conversion applications from insurance
Some advocates also are urging CMS to strengthen the rules
on notifications that must be sent to enrollees who find
themselves automatically signed up in an Advantage plan. The
current rules require insurance companies only to provide a
notification of enrollment by mail 60 days prior to seamless
conversion. The notification must include clear information on
how to opt out before coverage begins. But mailboxes typically
overflow with Medicare marketing pitches around one's 65th
birthday, making it easy to miss a notice of seamless
"Our preference would be that the process requires an active
choice, that you must respond to an invitation for a seamless
enrollment," said Joe Baker, president of the Medicare Rights
Center, a consumer advocacy organization.
Health insurance companies argue that seamless conversion is
convenient for its members, and has been well-received.
Aetna Inc is starting seamless conversion in 17
counties in Florida this fall for existing members of its
individual or public exchange plans who become eligible for
Medicare. "We will match them to a Medicare Advantage plan that
is very similar to what they're used to and enroll them
automatically," a spokesman said. The company's notification
process goes beyond the federal requirements, including a phone
call to make sure the notification letter was received, read and
UnitedHealthcare, meanwhile, recently received CMS
approval to use seamless enrollment for its Medicaid members in
Arizona into its Advantage plan for people who are dually
eligible for Medicare and Medicaid. The company also says it
will be following up its mailings with a phone call.
A CMS spokesman says it has seen "very few issues or
complaints" from consumers thus far regarding seamless
enrollment. The Medicare Rights Center, which operates a
toll-free hotline on Medicare for consumers, also has not seen a
large volume of complaints or problems, Baker said.
Baker thinks most seamless conversion activity involves
dual-eligible Medicaid plan members - and that is sensible from
a public policy standpoint. "It's a vulnerable population," he
said, "and you want to make sure there's no gap in coverage
because it could really affect a person's health." But
convenience alone is a questionable policy goal, he adds.
If anything, the seamless conversion debate underscores the
complexity of the transition into Medicare. Back in the days
when everyone filed for Social Security at age 65, enrollment
for Medicare was automatic.
But with more people working longer and delaying their
Social Security filing, the transition may involve shifting from
employer coverage or from a public marketplace policy. "The
transition is more fraught," Baker said. "It's really important
to open all your mail - especially anything that comes from an
insurance company that already covers you."
Free help with enrollment is available from Medicare's
toll-free line (1-800-MEDICARE), the Medicare Rights Center
(1-800-333-4114) or your local State Health Information Program.
Find your local program here (bit.ly/1OU0sfN) .
(Editing by Matthew Lewis)