Image from genealogy.about.com
Image from genealogy.about.com

Some seniors are surprised to know that they have been enrolled to a certain medical plan without their knowledge. The sad thing is; they only know about it at the time when they need their health insurance most, only to find out that the health services they availed is out of their plan’s network because there is a seamless continuation of coverage that they did not even requested.

It is clearly stated in the country’s Social Security Act (section 1851 (c)(3)(A)(ii)) that the private Medicare Advantage plan does not need to wait for a person to request for a coverage prior to enrollment to a plan as long as he was previously insured by the plan, regardless if it is a Medicaid plan or a commercial policy prior reaching the age of 65 or became eligible for a Medicare enrollment.

One example of this case is “Ms. M.” (not the real name) from Southwest. She just reached the age of 65 this fall and was expecting that she was enrolled to a Medigap plan as well as a Part D drug plan. Right after becoming eligible for Medicare, 2 surgeries were requested for Ms. M. with one month gap in between. Since she resides adjacent to the state line’s rural area, she opted to avail the services of the nearest hospital facility there. After the operation, she received a call from her doctor’s office telling her that her insurance claim has been denied. She is covered by a Medicare Advantage Plan and the hospital where the operation was done is not included on plan’s network.

“I called MA plan and was shocked to know that they have enrolled me on their plan since I  had a coverage with them before I joined Medicare, hence they were allowed to sign me in in one of their plans even without receiving any request from me”, Ms. M. said.

It was later found out that Ms. M. received a mail from Medicare Advantage, telling her about the enrollment to their plan but since she thought this is just one of their offers, she failed to read them. She could have the option to discontinue the enrollment.

However, the Center for Medicare Advocacy (CMA) took her case and intervened and Ms. M. was instructed to send a request to CMS, asking them to retroactively dis-enroll her from the MA plan.

But not all victims of the “automatic enrollment scheme” had the same fate as Ms. M. Others struggled to find justice on their mishaps. That is why Journalists Philip Moeller warns the public to look out for themselves since according to him, the giant health bureaucracy is likened to a full contact sport which is not meant for the meek.