David Lipschutz, JD, associate director of Center for Medicare Advocacy, a national nonprofit law organization that works to advance access to Medicare coverage, Washington, DC. MedicareAdvocacy.org
When Americans become Medicare eligible, typically at age 65, they can choose to enroll in a Medicare Advantage plan, which is a Medicare alternative offered by a private company. But some people have been automatically enrolled in Medicare Advantage plans that they did not choose.
Buried in the Medicare statutes is language allowing insurance companies to enroll their current customers in their Medicare Advantage plans when those customers first become Medicare eligible—even if those customers have not requested this. The process is known as “seamless conversion enrollment,” and based on anecdotal evidence, it appears to be increasingly common.
The insurance company must send a letter to the customer explaining what it intends to do. Unfortunately, customers often fail to understand this letter—if they read it at all.
This can have devastating financial consequences. Medicare Advantage plans tend to have limited provider networks, like HMOs, so these people could receive treatment from a provider who is not in network and have thousands of dollars in uncovered bills.
What to do: Carefully read all mail received from your current health insurance provider in the months leading up to your 65th birthday. If you come across anything suggesting that the insurance company intends to enroll you in a Medicare Advantage plan that you do not wish to have, contact the insurer and decline to be enrolled.
Approximately one month prior to Medicare eligibility, call your current insurer to confirm that you are not being automatically enrolled in a Medicare Advantage plan.
If you are enrolled in a Medicare Advantage plan against your wishes, call Medicare at 800-MEDICARE. People in this situation have been allowed to convert to traditional Medicare without having to wait until the next open-enrollment period. It even might be possible to be retroactively enrolled in Medicare so that out-of-network expenses already incurred are covered.