It looks like my Mom has been switched into a Humana Medicare Advantage plan without her consent. Again.

How does this happen, how can it be prevented, and how do I get her off this?

Report it to your State AG and State Insurance Commissioner.

Never say the words "Yes" or "OK" on the phone.

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Switching happens a bunch of ways. What was her previous/preferred plan? Eg, was it through a former employer? Was it a different MA plan or a non-Medicare retiree plan? We she recently in long term care?

Possible reasons that aren’t nefarious: her employer may have group-enrolled the plan members into the MA with an opt-out clause. Her employer may have changed plan providers from one MA to another. I have seen LTCs submit a plan change when the current plan doesn’t apply at that LTC necessary drugs not covered through current plan

She should be able to contact the new plan and ask how she was enrolled. She could also contact CMS and ask the same. Both sides can see how the enrollment was submitted to CMS (like through CMS directly or through the plan) if it went through the new plan, they can see how (like did joe smith represent that he had authorization to do it, or did her former employer do it, etc).

If it was done without consent and isn’t related to routine plan management by her employer (like, it was a truly fraudulent application), CMS can correct it/put her back where she was.

How did it happen the previous time?

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PeterW
How did it happen the previous time?

Nobody really knows. A letter just showed up.

Free, if you (your mom) files a complaint with Medicare, the mechanism of enrollment will be researched and you (your mom) will be notified. The way the complaint works is you file with CMS, they review and if needed forward to plan, and the plan will explain to both you and CMS. CMS can use that complaint as the trigger to get her back where she was.

Every enrollment can be tracked. If it was done on paper, you can get a copy. If it was done by phone, it’s recorded (CMS requirement). If it was submitted online, nothing for you to see but the submitter will have to have provided certain data which can be relayed to you (broker ID, purported representative, etc). If it was done by her former employer, that’s super easy to verify.

800-Medicare and ask to file a complaint. It’s your best option to get this looked at.

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TL
Free, if you (your mom) files a complaint with Medicare, the mechanism of enrollment will be researched and you (your mom) will be notified. The way the complaint works is you file with CMS, they review and if needed forward to plan, and the plan will explain to both you and CMS. CMS can use that complaint as the trigger to get her back where she was.

Every enrollment can be tracked. If it was done on paper, you can get a copy. If it was done by phone, it’s recorded (CMS requirement). If it was submitted online, nothing for you to see but the submitter will have to have provided certain data which can be relayed to you (broker ID, purported representative, etc). If it was done by her former employer, that’s super easy to verify.

800-Medicare and ask to file a complaint. It’s your best option to get this looked at.

Thanks

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freeradical

Quote
TL
Free, if you (your mom) files a complaint with Medicare, the mechanism of enrollment will be researched and you (your mom) will be notified. The way the complaint works is you file with CMS, they review and if needed forward to plan, and the plan will explain to both you and CMS. CMS can use that complaint as the trigger to get her back where she was.

Every enrollment can be tracked. If it was done on paper, you can get a copy. If it was done by phone, it’s recorded (CMS requirement). If it was submitted online, nothing for you to see but the submitter will have to have provided certain data which can be relayed to you (broker ID, purported representative, etc). If it was done by her former employer, that’s super easy to verify.

800-Medicare and ask to file a complaint. It’s your best option to get this looked at.

Thanks

Yes, thanks!

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