Medicare Rights Center and Partners Ask CMS to Revisit Seamless Conversion Practices

Last week, the Medicare Rights Center and partner organizations, including Justice in Aging, the Center for Medicare Advocacy, and the National Council on Aging, wrote to the Acting Administrator of the Centers for Medicare and Medicaid Services (CMS), to urge the agency to revisit the policy that allows certain private insurance companies to automatically enroll certain people into Medicare Advantage plans.

This process—called seamless conversion—allows private plans to automatically transition a person who is enrolled in one of the plan’s other products, like an individual commercial policy or a Medicaid Managed Care plan, into a Medicare Advantage plan when that person becomes Medicare eligible.

To use seamless conversion, an insurer must submit a plan to CMS and receive approval. Under current rules, insures must notify people who are being enrolled into the Medicare Advantage plan at least 60 days before the enrollment is to take place. The notice does not require the person to take any action or to confirm that they understand and accept the enrollment.

Beneficiary advocates raised concerns about an apparent uptick in the frequency of seamless conversion practices and about the risks associated with passive enrollment practices that do not require any affirmative actions on the part of enrollees. Particularly because conversion notices are sent just prior to a person’s Medicare eligibility, when they are likely to receive significant quantities of mail advertising Medicare products, it is easy to imagine how a person could skip over or misunderstand a seamless conversion notice.

Not understanding one’s enrollment status poses significant risks to beneficiaries. For example, a person unknowingly enrolled in a Medicare Advantage plan may inadvertently receive care from an out-of-network provider, potentially leading to significant out-of-pocket health care costs.

For this reason and others, the letter calls on CMS to allow seamless conversion only in limited circumstances and to enhance consumer protections related to this practice, such as by requiring write-in confirmation about enrollment in an MA plan and by further enhancing notification and outreach. The advocates also urge s CMS to inform beneficiaries, community-based organizations, and the public-at-large about where these practices are approved and to closely monitor plans for inappropriate use of the practice.

Read the letter.