Couple worried at computerOnly days after Judy Moore came home from the hospital after surgery last year, her doctor’s office called with distressing news. Her records showed that instead of original Medicare, Judy had a private Medicare Advantage plan. Her doctor and hospital were not in the plan’s network.

Neither the plan nor Medicare would now cover her medical costs. She owed $16,622.

“I was panicking,” said Judy [who lived in Carlsbad, New Mexico at the time]. After more than five hours of making phone calls, she learned that because she previously had individual coverage through Blue Cross Blue Shield when she became eligible for Medicare, Blue Cross Blue Shield automatically enrolled her into its own Medicare Advantage plan after notifying her in a letter. Judy said she ignored all mail from insurers because she had chosen traditional Medicare.

“I felt like I had insured myself properly with Medicare,” she said. “So I quit paying attention to the mail.”

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.

Medicare officials have refused to name the companies that have sought or received such approval or even to say how long the Centers for Medicare & Medicaid Services has allowed the practice. Numerous insurers, including Cigna, Anthem and other Blue Cross Blue Shield subsidiaries, also declined to discuss whether they are automatically enrolling beneficiaries when they turn 65.

And other insurers say they are moving ahead.

Aetna will begin the process soon for its marketplace members in 17 Florida counties. The effort will kick off with individuals who qualify for Medicare in November 2016, spokesman Matthew Clyburn said. Beneficiaries turning 65 will receive a 90-day advance notice instead of the required 60 days and a postcard they can mail back to Aetna. Then, the company will follow up by phone to make sure they understand the change.

In November 2016, United Healthcare will begin to automatically enroll members of its Medicaid plans in Tennessee and Arizona into its Medicare Advantage plans.

Humana, the nation’s second largest Medicare Advantage provider, has asked for federal permission to also do auto-enrollment. 

Medicare officials are developing a procedure for reviewing seamless conversion requests as well as a system to monitor implementation. A company given approval must automatically enroll all Medicare-eligible beneficiaries. But because federal law prohibits marketplace insurers from dropping a member who qualifies for Medicare, both marketplace and Medicare Advantage coverage continue until the person cancels the marketplace plan.

Sally Thompsen, who lives outside Chicago and had an individual health policy from Blue Cross Blue Shield last year, was more than surprised when she received her member card for a Medicare Advantage plan shortly before turning 65. Printed on the card was the name of her new primary care physician, someone she did not know.

“I almost hit the ceiling,” said Sally, who had already enrolled in traditional Medicare.

She demanded that Blue Cross cancel her Medicare Advantage enrollment and reported the situation to Erin Weir, health care access manager at the local advocacy group AgeOptions. Erin heard a similar story from another local woman, who had received a letter from her insurer saying a Medicare Advantage plan was “selected for you because it is similar to your current plan and unless you contact us, you will be automatically enrolled.”

After learning about the problem both from constituents and health care advocates, Rep. Jan Schakowsky (D-Ill.) wants stronger consumer protections. “I am exploring the option of requiring an ‘opt-in’ so that Medicare beneficiaries are adequately informed and able to make the choices that work best for them,” said Schakowsky, whose district includes the Chicago area.

The Lovelace Medicare Advantage plan, in which Judy Moore found herself enrolled, is run by Health Care Service Corporation, which administers Blue Cross Blue Shield plans covering 15 million beneficiaries in Illinois, Montana, New Mexico, Oklahoma and Texas. A Health Care Service spokeswoman said it “offers seamless conversion enrollment on a limited basis.” She would not provide details.

Judy Moore finally solved her dilemma with help from a Medicare counselor at New Mexico’s Aging and Disability Resource Center, who contacted David Lipschutz, a senior attorney at the Center for Medicare Advocacy in Washington. He advised the counselor to tell Medicare officials that the retiree was enrolled in Medicare Advantage without her knowledge even though enrollment must be voluntary.

Eventually, officials disenrolled Judy from her unwanted plan, restored her traditional Medicare coverage and agreed to cover her medical bills.

Lipschutz said giving beneficiaries the chance to opt out does not adequately safeguard consumers. An insurer’s notification letter can easily be mistaken or overlooked in the deluge of marketing materials seniors receive when turning 65.

“The right to opt out does not exist if a Medicare beneficiary does not receive a notice or if they do receive a notice but do not understand the contents,” he said.