December 20, 2016
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Auto Enrolling Members into Medicare Advantage Plans
by Erin Fisher

We thought it would be important to make a note of an issue that is occurring throughout the country. Some health carriers are auto enrolling their members who are turning 65 into that carrier’s Medicare Advantage (MA) plan.

Although these individuals are receiving notices in the mail informing them of this auto enrollment, the individuals say it appears as junk mail or something the carrier is trying to sell them. Therefore, the notice is not read.

Once enrolled in the MA plan, the member could have two plans, thus they are paying for two plan premiums (the under 65 plan and the MA plan). We all know the rules of leaving a MA plan, so these auto enrollees who do not want the MA plan are in a difficult situation when they want to disenroll.

The members find out about the enrollment into the other plan when they see a doctor, go to the emergency room or when they are discharged from a hospital and receive an unexpected bill in the mail.

We are developing a NAHU position on this practice, of particular concern is when there is no active broker of record. In addition, the notice could require an individual to opt in. Currently, these programs provide an opt-out feature.

Separately, the Centers for Medicare and Medicaid Services recently announced a new, five-year pilot program, Medicare Advantage Value Based Insurance Design (MAVBID). The pilot will begin in 2017 in select states and for specific chronic diseases. States included are: Arizona, Oregon, Tennessee, Indiana, Iowa, Massachusetts, and Pennsylvania. It will cover: dementia, diabetes, chronic obstructive pulmonary disease, mood disorders, congestive heart failure, hypertension and coronary artery disease.

The carriers participating in this pilot will be announced in September. The goal is to improve quality of care and reduce costs.

Editor’s Note: CMS recently halted review of any carrier proposals for seamless conversions and is reviewing those carrier approvals previously granted. It is highly likely that the attention given to this matter will result in the discontinuation of this practice without the involvement of a licensed agent/broker.

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