Medicare Advantage Auto-Enrollment at Age 65

[MBSC]

More health insurers are seeking permission to automatically enroll members turning age 65 into their Medicare Advantage plan.

With Medicare’s specific approval, a health insurance company can enroll a member of its marketplace or other commercial plan into its Medicare Advantage coverage when that individual becomes eligible for Medicare. Called “seamless conversion,” the process requires the insurer to send a letter explaining the new coverage, which takes effect unless the member opts out within 60 days.

An insurer’s notification letter can easily be mistaken or overlooked in the deluge of marketing materials seniors receive.

Source: Some Seniors Surprised To Be Automatically Enrolled In Medicare Advantage Plans | Kaiser Health News

 

[MichaelB]

Opt out? By an insurance company? Yikes! I don't know how many of these Medicare Advantage letters we've received so far, but it must be close to 50, and I've tossed them all. What a bad idea.

 

[FIRE'd@51]

Opt out? By an insurance company? Yikes!..... What a bad idea.

+1

Do some research and think very carefully about going the Medicare Advantage route instead of Original Medicare with a Supplemental policy. You only have one opportunity to get this right without potentially facing underwriting should you want to buy a Supplemental policy in the future.

 

[Silver]

+1

Do some research and think very carefully about going the Medicare Advantage route instead of Original Medicare with a Supplemental policy. You only have one opportunity to get this right without potentially facing underwriting should you want to buy a Supplemental policy in the future.

Big +1 on this. Just turning 65 this month and have done extensive research on the options. What is not always as clear, IMO, is that you have only 6 months within which to make a decision about standard medicare and a supplement at the starting prices.....and then that option is gone.

I have gotten the standard medicare and high deductible Plan F, and am pleased with that decision. I also have the Humana/Wal-Mart drug plan. I feel it provides the coverage I need now, and the most opportunity for changes as needed in the future.

 

[Gotadimple]

More health insurers are seeking permission to automatically enroll members turning age 65 into their Medicare Advantage plan.

Source: Some Seniors Surprised To Be Automatically Enrolled In Medicare Advantage Plans | Kaiser Health News

Health plans have been doing this for years with their supplemental plans. It's called "Aging In." If you are currently a member on one of their individual plans, they send you a letter saying they will convert you as you turn 65. You have to contact them if that is not what you want.

- Rita

 

[mf15]

I was thrilled, when Aetna pulled out of their advantage
plans, now the wife has Plan F HD, which we both like.
Once you are in an advantage plan, you cannot get out without underwriting,
unless you move, or the plan is cancelled. If companies are doing an auto enrollment, that is not a good thing. The trick is finding an HD plan and
comparing monthly cost, for me 68/month right now.


Our experience with F HD so far so good, wife went to the ER about
5 grand for 4 hours, cost me about $250. Medicare picked up most of it,
the actual insurance never even kicked in.
Old Mike

 

[razztazz]

Sounds like Government sponsored single payer but with profits in it for somebody.

 

[Gotadimple]

Sounds like Government sponsored single payer but with profits in it for somebody.

AKA Medicare Advantage.

The single payer is the government, who turns most of the Part B premium over to an insurance company.

The profit is the insurance company betting they can negotiate the cost of care to be less than the Government payment + any premium they charge for the Medicare Advantage plan.

With Medicare Supplement, the Government is the single payer, with the Supplement insurer betting they can negotiate a lower rate for the non-covered services (deductibles, etc) than what they take in in premiums.

 

[aja8888]

AKA Medicare Advantage.

The single payer is the government, who turns most of the Part B premium over to an insurance company.

The profit is the insurance company betting they can negotiate the cost of care to be less than the Government payment + any premium they charge for the Medicare Advantage plan.

With Medicare Supplement, the Government is the single payer, with the Supplement insurer betting they can negotiate a lower rate for the non-covered services (deductibles, etc) than what they take in in premiums.

The supplement insurers pay the full deductible amount on certain plans (full plan F for example). Under Medicare, the deductibles are collected in full for all services requiring deductible.

Supplemental insurers also pay the service providers on services Medicare does not cover fully. I suspect the supplement insurers negotiate with the service providers the amount to pay that Medicare did not pay.

 

[MichaelB]

The WaPo reports that this practice of automatically enrolling policyholders into Medicare Advantage policies has been suspended. https://www.washingtonpost.com/nati...add04c-9af6-11e6-a0ed-ab0774c1eaa5_story.html

The federal government is temporarily blocking more health insurance companies from automatically moving customers who become eligible for Medicare into Medicare Advantage plans while officials review the controversial practice.

 

[Another Reader]

Considering the difficulty of changing plans, this should be illegal and there should be compensation for anyone that was damaged by this practice.

 

[Bamaman]

We continue to see massive numbers of physicians selling their practices to large hospital chains, and they become independent sub-contractors. Their office staffs become employees of the hospitals.

Vanderbilt Hospital in Nashville, TN has already bought so many doctors' offices that they have 1,700 physicians, PA's and CNP's working for them. Vanderbilt has chosen to opt out of Medicare Advantage programs starting in 2016.

Thousands of Medicare Advantage members in Tennessee and Kentucky have had to change physicians (if they can find one not owned by Vandy) or they've had to travel to other cities for healthcare. They're also having to find other hospitals to go to which may not be as good as Vanderbilt is in dealing with their specific problems.

It appears that hospitals are finding the Advantage plans to be unprofitable to deal with.

I'm sticking with Medicare with the standard supplement package offered by my ex-employer to retirees.

 

[travelover]

The WaPo reports that this practice of automatically enrolling policyholders into Medicare Advantage policies has been suspended. https://www.washingtonpost.com/nati...add04c-9af6-11e6-a0ed-ab0774c1eaa5_story.html

Thanks for posting this. My DW gets paid healthcare as a retiree, but her plan papers indicate that she will automatically be switched to Medicare Advantage when she turns 65. I'll be following to see is this action affects her choices once she hits Medicare age.

 

[Another Reader]

Thanks for posting this. My DW gets paid healthcare as a retiree, but her plan papers indicate that she will automatically be switched to Medicare Advantage when she turns 65. I'll be following to see is this action affects her choices once she hits Medicare age.

You should act BEFORE she is enrolled in a Medicare Advantage plan. Getting out of an Advantage plan requires medical underwriting and acceptance is at the discretion of the insurer.

 

[aja8888]

Thanks for posting this. My DW gets paid healthcare as a retiree, but her plan papers indicate that she will automatically be switched to Medicare Advantage when she turns 65. I'll be following to see is this action affects her choices once she hits Medicare age.

Try to avoid getting enrolled in one of those plans if possible.

 

[MRG]

I was thrilled, when Aetna pulled out of their advantage
plans, now the wife has Plan F HD, which we both like.
Once you are in an advantage plan, you cannot get out without underwriting,
unless you move, or the plan is cancelled. If companies are doing an auto enrollment, that is not a good thing. The trick is finding an HD plan and
comparing monthly cost, for me 68/month right now.


Our experience with F HD so far so good, wife went to the ER about
5 grand for 4 hours, cost me about $250. Medicare picked up most of it,
the actual insurance never even kicked in.
Old Mike

There's a third way, only if you are on SSDI and are taking Medicare before 65. At 65 you have another chance without underwriting.

 

[meierlde]

You should act BEFORE she is enrolled in a Medicare Advantage plan. Getting out of an Advantage plan requires medical underwriting and acceptance is at the discretion of the insurer.

Note the open enrollement period does extend for 3 months after you start medicare.
Further "When you return to regular Medicare, you have the right to go back to the same Medigap policy you had before you joined the Medicare Advantage plan, if the same insurance company you had before still sells it. If the policy is no longer available, you have a guaranteed right to buy a Medigap policy designated A, B, C, F, K or L that is sold in your state by any insurance company as long as you had Medicare Advantage for less than a year. In these circumstances the insurers cannot refuse you coverage as long as you apply for the Medigap policy no later than 63 days after coverage from your Medicare Advantage plan terminates. The insurance company is required to by law to sell or offer you a Medigap policy even if you have health problems (called "pre-existing conditions"). If you had Medicaid Advantage for a year or more or wait longer than 63 days, you can apply but you aren’t guaranteed of acceptance."

It appears that by going to an SS office you can also unenroll. But the critical thing is to read mail.

 

[MichaelB]

Thanks for posting this. My DW gets paid healthcare as a retiree, but her plan papers indicate that she will automatically be switched to Medicare Advantage when she turns 65. I'll be following to see is this action affects her choices once she hits Medicare age.

Does she have any option to choose the plan, or choose a traditional Medicare plan? If not, the only alternative you would have is to disregard the retiree benefit and pay her Medicare B + D + Medigap our of your own pocket.

Medicare Advantage plans are not automatically "bad" or necessarily worse than traditional Medicare. Most often, they are limited in some way, such as network, and have higher levels of cost sharing.

 

[travelover]

Does she have any option to choose the plan, or choose a traditional Medicare plan? If not, the only alternative you would have is to disregard the retiree benefit and pay her Medicare B + D + Medigap our of your own pocket.

She does not have an option at this time, but she is only 60. I'm curious to see if this action forces them to offer an option.

Medicare Advantage plans are not automatically "bad" or necessarily worse than traditional Medicare. Most often, they are limited in some way, such as network, and have higher levels of cost sharing.

Right. My concern is that we travel a lot and a Medigap plan might be more useful for out of area coverage.

 

[calico1597]

I'll become a member of the Club Medicare next spring. I read every article I see to educate myself. So far I've learned that being snow birds that we want to stay clear of the Medicare Advantage Programs.

 

[Corporateburnout]

DW will be Medicare eligible next spring so we started researching the various available plans in our state. We will go the Medigap route as well because it covers us when we travel abroad.

In our state there are two available choices of Medigap policies, the Core plan that does not pay part A and B deductibles and the Supplement one plan that pays all deductibles. State laws allows us to switch between plans at any time of year with coverage starting at the beginning of each month. So if we're enrolled in the Core plan and in need of an elective surgery we are able to switch to the Supplement one plan that will cover all deductibles.

Also BCBS of MA offers a 15% discounted premiums for the first year, 10% for the second and 5% for the third. So she will most likely sign up with them.