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You spent time researching your Medicare Plan Options and found the plan that fits your needs and includes the doctors, providers, and prescriptions you are using.  Did you realize you could be enrolled in a plan that doesn’t fit your needs at all?  You can.  It’s called the “Seamless Conversion Enrollment”.


The Centers for Medicare and Medicaid Services (CMS) allows Medicare Advantage (MA) plan sponsors who also write medical coverage for those under age 65, to automatically enroll individuals in one of their MA plans when they turn 65.  If you are enrolled in this fashion, it is your responsibility to opt out of the coverage.  While they have to perform “Outreach Activity”, in some cases this may only be a letter informing you that you have been enrolled in a plan.  This notice can be easily lost in the rush of Medicare plan literature that individuals receive in the months leading up to their eligibility for Medicare.


This type of enrollment can lead to many problems for a Medicare beneficiary.  You could be enrolled in a plan with a network that does not have your doctors or hospitals, leading to extremely expensive out-of-network costs, or even worse, no coverage at all.  Once you are enrolled in a Medicare Advantage (MA or MAPD plan) original Medicare will no longer pay for your Medicare-covered Part A and Part B services.  If the MA plan you have been automatically enrolled in won’t pay the providers you have used, you are responsible for the bill.  This could lead to thousands of dollars in uncovered medical expenses.  In addition, the enrollment would count as your enrollment period if that plan is an MAPD, a Medicare Advantage Plan that had Part D prescription drug coverage.  Using up your enrollment period would mean that you cannot change your plan until the next Annual Election Period that is from October 15 to December 7th each year.


It is your responsibility to affirmatively opt-out of this enrollment if you don’t want the plan.  The problem with this is that CMS does not publish a list of plan sponsors that do “Seamless Conversion Enrollments” nor do the insurance companies that do this type of enrollment have to tell you they intend to enroll you in one of their MA plans if you are covered by one of their under-65 commercial medical plans and become eligible for Medicare.


The best course of action is to work with an independent agent, like Okun Insurance that specializes in Medicare coverage and can help you navigate the ins and outs of this important decision.  They can assist you in finding the right fit in coverage for your needs and budget.

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