shows the front of a Medicare card
Image courtesy Centers for Medicare and Medicaid Services

Are you a health care worker? We’d love to hear from you. Email editor at northcarolinahealthnews.org


By Thomas Goldsmith

The Centers for Medicare and Medicaid Services is backing away from a controversial “seamless conversion” policy, temporarily suspending the practice for new applications from insurance companies and allowing those enrolled under it to re-enroll in other plans including traditional Medicare.

Under seamless conversion, an insurance company has been allowed to notify a beneficiary approaching 65 that the person had been automatically enrolled in a company’s private “Medicare Advantage” plan instead of traditional Medicare. The person who was notified — often as part of countless mailings from Medicare-related providers — had to take an active step to opt out of the Medicare Advantage coverage.

Advocates for older people and Medicare beneficiaries had spoken out against the practice on the basis that recipients could unknowingly be enrolled in plans that offered them less advantageous coverage than traditional Medicare. Medicare Advantage plans work well for some recipients, but people signing up for Medicare are advised to look closely at how well any plan meets individual needs before enrollment.

“If an individual wishes to select another Medicare health or drug plan, that enrollment will supersede the seamless conversion,” when the beneficiary makes the change before the end of the enrollment period, CMS wrote in policy guidelines issued Friday.

“Individuals who wish to enroll in Original Medicare need to contact the Medicare Advantage organization prior to the Medicare advantage coverage effective date to opt-out of the proposed enrollment.”

More than 15,000 people nationally have been enrolled in plans using this type of conversion, a CMS spokesman said Friday when announcing that the practice was being suspended. No North Carolina plan had opted to take part as of Friday. A CMS spokesman said by email this week the agency does not know the number of those who were enrolled through seamless conversion.

Companies that have already gotten approval to use seamless conversion may continue the practice, but CMS is planning more robust consumer education.

“CMS 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 agency spokesman said.

In addition, the spokesman wrote, CMS will soon release clarifying information about seamless conversion, including administrative steps to make sure that those already enrolled under it are properly protected.

[box style=”2″]

Know your options

The Medicare enrollment period is underway. North Carolinians faced with a bewildering choice of options on basic, supplemental and prescription drug insurance can consult the free Seniors’ Health Insurance Information Program for individualized guidance.

Visit: www.ncdoi.com/SHIIP/Default.aspx

Call: 855-408-1212 (toll-free)[/box]

Clarification: An earlier version of this story neglected to say the suspension was temporary and applied only to companies making new proposals to use seamless conversion.

Republish our articles for free, online or in print, under a Creative Commons license.

Thomas Goldsmith

Thomas Goldsmith worked in daily newspapers for 33 years before joining North Carolina Health News. Goldsmith is a native Tar Heel who attended the UNC-Chapel Hill, and worked at newspapers in Tennessee...

2 replies on “Medicare Suspends “Seamless Conversion” Practice, Allows For Re-enrollment”

  1. Actually, they did NOT suspend Seamless Conversions. They suspended approving any NEW applications from Medicare Advantage companies that wanted approval to do this practice. There are, currently, more than 20 companies that are doing it and will continue. These include Humana, CIGNA, Aetna, and others.

    1. Thank you for your comment. You’ll notice we’ve corrected the story and added updates. I appreciate your sharp eye.

Comments are closed.