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Blue Shield And Blue Cross

The CMS has decided to temporary discard all new proposals from health insurance companies, who are seeking to enroll their Medicaid or commercial patients directly into their own Medicare Advantage plans. The federal agency stated that 29 Medicare Advantage companies which includes UnitedHealth Group, Aetna, and many other Blue Shield and Blue Cross insures can move their clients, who are currently enrolled in the regular plan to Medicare Advantage products, once they turn 65. The approval was granted to almost half of the companies, which indicates the growing desire among insurers to shift their aging members in to the lucrative Medicare plans.

This process, commonly known as seamless conversion, was highlighted in a recent story published by the Kaiser Health News. The story explained how this conversion affected the aging members, who were separately shifted into an alternative private Medicare Advantage plan. Many individuals also received huge medical bills even though they were enrolled in the traditional Medicare.

One of the major disadvantages of Medicare Advantage plans is that they have very narrow networks when compared to traditional Medicare. This means that not all pharmacies, hospitals, and doctors are available at in-network rates for the individuals, who were enrolled into this plan.

In a recent memo, Michael Crochunis, the acting director of the CMS Medicare Enrollment and Appeals Group, stated that the CMS has temporary suspended the approval of seamless conversion proposals and they are reviewing the policy “in light of recent inquiries.”

The federal law permits the Medicare Advantage insurers to provide seamless conversion enrollment to their newly eligible Medicare beneficiaries “currently enrolled in a health plan offered by the organization,” such as an employer-based plan or a Medicaid managed-care plan. However, insurers are also liable to alert the members at least 60 days before the seamless conversion and they should provide instructions on how to opt out from the conversion. In addition to that, CMS should also approve the request from insurers.

Medical Billing India

Health Insurance Companies

A CMS spokesman said that 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.”

CMS had not revealed any details on the insurers, who were eligible for seamless conversion earlier. However, the latest documents released by the government indicate that the approval was granted to 29 Medicare Advantage insurers, of which, 15 were approved in 2016 alone.