Don’t Get Caught: Medicare Advantage “Seamless Conversion”

Seamless Conversion Letter

Are you new to Medicare and confused why you were switched over to a Medicare Advantage Plan when you really wanted to be enrolled in Original Medicare?

There is a new term surfacing in the world of Medicare and it is called “Seamless Conversion”.

Here’s what happens. You are currently employed and covered by a group health plan or you could be covered by Medicaid run by an insurance company. Many of these insurers also offer Medicare Advantage plans. Medicare Advantage plans are managed-care run by insurance companies which are alternatives to Original Medicare.

There is a little-known process that is authorized by the federal government and insurers can shift their beneficiaries who are turning 65 to their own Medicare Advantage plan. This is what is called “Seamless Conversion”.

All that is required is for the healthcare provider is to obtain Medicare’s prior approval and they are required to send you a letter to explain your new coverage that will take effect on your Medicare eligibility date unless you opt-out within 60 days.

This “seamless conversion” can include newly-eligible Medicare situations such as:

  • Turning 65 and eligible for Medicare
  • Eligible for Medicare due to disability
  • Transitioning from Affordable Care plan into Medicare

Read – Read – Read

Prior to becoming eligible for Medicare you will probably receive lots and lots of mail! One of the pieces of mail you might receive is the “seamless conversion” letter.

As much as we all dislike that junk mail, it is important to read any letter coming from your Health Insurance Company and CMS as this could affect your current and future coverage of Medicare.

The Good News

All Medicare beneficiaries have a 12-month period to try out a Medicare Advantage plan. If at anytime during this 12 month period you are not satisfied with the plan, you can disenroll at anytime prior to your one-year anniversary of becoming eligible for Medicare. You can rejoin Original Medicare and still have guaranteed issue rights to purchase a Medigap policy and a Part D Drug plan. You cannot be denied coverage by the Medigap insurance company no matter what your health status is.

Don’t let an insurance company dictate your future healthcare. You want to be able to make your own choice as to how you want to receive your Medicare benefits.

________________

For a full explanation you can read the Medicare Managed Care Eligibility & Enrollment Manual, Chapter 2. https://www.cms.gov/Medicare/Eligibility-andEnrollment/MedicareMangCareEligEnrol/Downloads/CY_2016_MA_Enrollment_and_Disenrollment_Guidance.pdf

 

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