Doctors say they're losing patients when commercial health plans automatically move consumers to a Medicare Advantage plan when they turn 65. The Medicare Advantage plans mean more revenue for insurers, but it often means patients' doctors will be considered out of network.
A policy known as seamless conversion allows insurance companies to move members of their commercial or Medicaid managed-care plans over to Medicare Advantage plans if they first ask permission from the CMS.
In an effort to ensure continuity of care, the CMS has been increasingly encouraging the practice. A recent memo reminded Medicare Advantage plans about seamless conversion as a way to transition enrollees in Medicaid managed-care plans to integrated dual special-needs plans once the enrollee is Medicare-eligible.
The CMS has not said which insurers have asked for this permission. But a Kaiser Health News story this summer said that Aetna, Humana and UnitedHealthcare were all asking for permission to participate in seamless conversion.
Providers, however, are increasingly growing concerned about the policy.
“The seamless conversion merely insures that carriers keep their member base: it does not facilitate continuity of care; it does not facilitate the patient-physician relationship,” Melinda Martinson, general counsel for the Medical Society of New Jersey said in a letter sent to the CMS last month.
New Jersey United Healthcare's Medicare Advantage plan tightened its network several years ago. Physicians dropped from the plan continued to participate in UnitedHealthcare's commercial plans.
Martinson wants the CMS to evaluate whether seamless conversion is as advantageous to seniors as it is to insurers and their financial interests.
The concerns are shared nationally by other doctors. “Clearly, when a patient's non-Medicare insurance has been covering their care from a particular physician and this physician is not in the MA plan's network, the result is far from seamless,” Dr. James Madara, AMA's CEO, said in a letter to the agency.
The trade group is pushing for the CMS to publicly release information on which Medicare Advantage plans have been approved so that more outreach about the process can take place in those regions.
Advocates are also raising red flags about the policy. “It concerns us that people new to Medicare are auto-enrolled in MA plans through a seamless conversion process that does not necessarily give preference to their current health care providers, medications, needed services, and so forth,” a joint letter from the Medicare Rights Center, Justice in Aging, Center for Medicare Advocacy and National Council on Aging says.
“Instead, it depends on whether the MA plan is owned and operated by the same parent organization as their previous coverage.”
The groups are pushing the CMS to require insurers to get confirmation from a beneficiary that they understand their network may have changed and allow for a special enrollment period in case their doctors aren't in network.
A CMS spokesman countered that beneficiaries should be more vigilant in opening and reviewing all mail from their current insurer and if they are contacted about automatic enrollment into a Medicare Advantage plan, they should make sure to ask about provider and pharmacy networks. The CMS said patients can opt out.
He said the agency later this year will make public which insurers use seamless conversion.
