The CMS has temporarily stopped accepting new proposals from health insurance companies seeking to automatically enroll their commercial or Medicaid patients into their Medicare Advantage plans.
The federal agency also disclosed that 29 Medicare Advantage companies—including Aetna, UnitedHealth Group and several Blue Cross and Blue Shield insurers—can move consumers who had been enrolled in a regular plan into their Medicare Advantage products once the consumers turn 65 years old. Half of the companies received their approval this year, signaling a growing desire from insurers to move their aging members into their lucrative Medicare plans.
The process is called seamless conversion and was profiled in a recent Kaiser Health News story, which detailed how seniors were shocked to be enrolled in a private Medicare Advantage plan and received unexpected medical bills even though they had enrolled themselves in traditional Medicare. Medicare Advantage plans have narrow networks, unlike traditional Medicare, so not all hospitals, doctors and pharmacies are available to enrollees at in-network rates.
Michael Crochunis, acting director of the CMS' Medicare Enrollment and Appeals Group, sent a memo (PDF) late Friday that said the agency instituted the temporary moratorium on approving seamless conversion proposals and is reviewing the policy “in light of recent inquiries.”
Federal law allows Medicare Advantage insurers to offer seamless conversion enrollment to newly eligible Medicare beneficiaries “currently enrolled in a health plan offered by the organization,” such as a Medicaid managed-care plan or an employer-based plan. However, the CMS must approve the request. Insurers also must send a letter to those members at least 60 days in advance notifying them of the seamless conversion and providing instructions about how to opt out.
Doctors have criticized the policy, saying it values an insurance company's membership over the patient-physician relationship.
A CMS spokesman said the agency “continues to look for ways to improve the seamless enrollment process and to ensure that automatic enrollment into the Medicare Advantage plan is line with the beneficiary's wishes and is not the result of a lack of understanding on the part of the beneficiary of the need to deliberately decline the Medicare Advantage enrollment if it is not desired.”
The CMS previously did not reveal which insurers have received permission for seamless conversion. But new documents released by the government show 29 Medicare Advantage insurers have nabbed approval. Fifteen have received approval from the CMS since the beginning of this year alone.
In 2015, a little more than 15,000 newly eligible Medicare beneficiaries were initially enrolled with companies that are able to use seamless conversion. However, seamless conversion enrollments are only a subset of those initial enrollment selections, so the 15,000 figure is “higher than the actual use of the seamless conversation enrollment mechanism,” the CMS said.
The full list of Medicare Advantage insurers that have received approval for seamless conversion enrollments can be found here. The CMS said the chart will be updated annually.
Consumer advocacy groups lauded the CMS's moratorium and said they are pleased with the moves to make the policy more transparent.
Joe Baker, president of the Medicare Rights Center, said the CMS data will help patient awareness of the policy. The data also will allow the CMS to monitor whether health plans are automatically enrolling patients into Medicare Advantage plans even if they haven't been approved to do so by the CMS.
While the Medicare Rights Center doesn't receive a ton of calls from consumers who have been affected by seamless conversion, the number has been growing. Still, seamless conversion can have a huge impact on an individual, he said. A chief criticism of the policy is that affected patients often don't know they are enrolled in Medicare Advantage plans and unwittingly rack up big medical bills because their doctor isn't in the network.
“The whole notion of Medicare is to be able to choose the coverage that's right for you,” Baker said.
“We are very pleased with the moratorium and the plans to review the policy, because we really think they need to have additional attention on protecting and encouraging consumer choice,” said Georgia Burke, directing attorney for Justice in Aging. The legal advocacy organization is pushing for the CMS to require some sort of affirmation from beneficiaries to indicate they understand the seamless conversion policy and accept it.
The Medicare Rights Center and Justice in Aging, along with the Center for Medicare Advocacy and the National Council on Aging, sent a joint letter to the CMS administrator Andy Slavitt in September urging the agency to limit seamless conversions and to advance policies that encourage newly eligible beneficiaries to actively choose their health coverage, as the ability to opt-out of a plan is not the same as “active decision-making,” they said. Additionally, being converted to a Medicare Advantage plan can make it difficult for a patient to purchase a Medigap policy later.
“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,” the letter states.
In the letter, the groups also proposed several consumer protections, such as requiring insurers to obtain written confirmation from beneficiaries before they enroll them in a Medicare Advantage plan, adding a special enrollment period allowing beneficiaries to elect another plan if they choose, and requiring insurers to notify beneficiaries more than once about the seamless conversion.
