About to Turn 65? Your Health Insurer May Be Automatically Enrolling You in Its Own Medicare Plan

July 29, 2016

As people approach age 65, they should be thinking about their Medicare enrollment choices, including whether to sign up for traditional Medicare or with a Medicare Advantage plan, and if so, which one. But it turns out that some Medicare-age people are having these important decisions made for them, often without their knowledge.

Before they become eligible for Medicare, many Americans are covered by a commercial or a Medicaid health care plan run by an insurance company. These insurers often also operate Medicare Advantage plans, which are the privately run managed-care alternative to traditional Medicare. Under a little-known process authorized by the federal government, insurers can shift their beneficiaries who are turning 65 to their own Medicare Advantage plan. It’s called “seamless conversion,” and all it requires is that the health plan obtain Medicare’s prior approval and send a letter to the beneficiary explaining the new coverage, which takes effect unless the member opts out within 60 days.

The idea is to preserve continuity for those who want to stay with the same company, but some seniors are unaware that they have been signed up, in part due to the flood of mail they get from insurers around age 65. In a recent Kaiser Health News expose, reporter Susan Jaffe related the stories of several new Medicare beneficiaries who were shocked to learn that they had been enrolled in a Medicare Advantage plan. One, Judy Hanttula of Carlsbad, New Mexico, signed up for traditional Medicare and then ignored the subsequent mail, which apparently included the notice from her insurer telling her that it had automatically enrolled her in its Medicare Advantage plan.

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

Unfortunately for Ms. Hanttula, before she became aware of the automatic assignment to a Medicare Advantage plan, she had surgery that her new plan subsequently refused to cover, leaving her with a $16,622 bill. Eventually, with the help of David Lipschutz, a senior attorney at the Center for Medicare Advocacy in Washington, Medicare officials disenrolled Ms. Hanttula from her unwanted Medicare Advantage plan, restored her traditional Medicare coverage and agreed to cover her medical bills, reports Jaffe.

Medicare officials won’t say which insurance companies have sought or received approval to seamlessly convert their members to their own Medicare Advantage plans, but Jaffe reports that among the insurers that are already automatically enrolling members into Medicare plans in at least some parts of the country include Aetna and United Healthcare and that Humana, he nation’s second-largest Medicare Advantage provider, has asked for federal permission to also do auto-enrollment.

Medicare officials are developing procedures for seamless conversion requests and implementation, but in response to complaints from her constituents and health care advocates, Rep. Jan Schakowsky (D-Ill.) wants to build in stronger consumer protections.

In the meantime, those enrolled in a health plan offered by a Medicare Advantage organization when they become eligible for Medicare should “be attentive,” says attorney Lipschutz of the Center for Medicare Advocacy. “Be on the lookout for written notice regarding conversion and carefully consider whether to opt-out of the [Medicare Advantage] plan.”

For a Center for Medicare Advocacy case study on the seamless conversion issue, click here.

To read the Kaiser Health News article, click here.

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What Is Undue Influence?

Saying that there has been “undue influence” is often used as a reason to contest a will or estate plan, but what does it mean?

Undue influence occurs when someone exerts pressure on an individual, causing that individual to act contrary to his or her wishes and to the benefit of the influencer or the influencer’s friends. The pressure can take the form of deception, harassment, threats, or isolation. Often the influencer separates the individual from their loved ones in order to coerce. The elderly and infirm are usually more susceptible to undue influence.

To prove a loved one was subject to undue influence in drafting an estate plan, you have to show that the loved one disposed of his or her property in a way that was unexpected under the circumstances, that he or she is susceptible to undue influence (because of illness, age, frailty, or a special relationship with the influencer), and that the person who exerted the influence had the opportunity to do so. Generally, the burden of proving undue influence is on the person asserting undue influence. However, if the alleged influencer had a fiduciary relationship with your loved one, the burden may be on the influencer to prove that there was no undue influence. People who have a fiduciary relationship can include a child, a spouse, or an agent under a power of attorney. For more information on contesting a will, go here.

When drawing up a will or estate plan, it is important to avoid even the appearance of undue influence. For example, if you are planning on leaving everything to your daughter who is also your primary caregiver, your other children may argue that your daughter took advantage of her position to influence you. To avoid the appearance of undue influence, do not involve any family members who are inheriting under your will in drafting your will. Family members should not be present when you discuss the will with your attorney or when you sign it. To be totally safe, family members shouldn’t even drive or accompany you to the attorney’s office. You can also get a formal assessment of your mental capabilities done by a medical professional before you draft estate planning documents. For more information on preventing a will contest, go here.

July 14, 2016

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