Trial Rights

What Are Trial Rights?

You thought that you had chosen the right plan in a Medicare Advantage plan, but what if this is not really the right plan for you? Will you still be able to change your plan even though you are already enrolled?

The answer MIGHT be yes. But it MIGHT be NO.

Luckily for Medicare beneficiaries, there is a trial period. You don’t need to get stuck in a plan that you don’t like. With the trial period, you may be able to leave your Medicare Advantage plan and return to (or join) a Medicare Supplement (Medigap) plan, if you are within the first 12 months of the Medicare Advantage plan enrollment. This is called the “trial period”. However, many insurance agents, and even Medicare Advantage Company representatives, leave an important fact out of their explanation to you.

What is that important fact?

Your trial right only exists if your Part A, Part B, and Medicare Advantage Plan all started when you were FIRST ELIGIBLE for Medicare. For most, they were first eligible for Part A when they turned 65.  So if you start Part A, or delay Part A or B, and then sign up later, you DON’T have a trial right.

That’s correct.  You don’t have a trial right in this instance.

And this happens more than you’d think.  Many people are delaying beginning Part B because they are covered under an employer plan.  It could be your own employer’s plan or it could be a spousal plan that you’ve decided to keep.  And since Part A is free for most of us, most people start Part A when they are first eligible at age 65.

Then when they get their Part B after the employer plan ends, they are given the wrong information that they have a trial right.  And unfortunately, they don’t.  The trial right only exists if you joined a Medicare Advantage plan when you were first eligible for Medicare 65.

But if you DO qualify for a trial right, you can go back to Original Medicare and purchase a Medigap plan with no medical underwriting. This means you would be offered a guaranteed issue for the Medicare Supplement Plan. Keep in mind the 12-month trial period for your Medicare Advantage plan. If you don’t cancel your plan before that trial period, you will lose the chance to exercise your trial rights and, you may be subject to medical underwriting. You can only use this option once, so think it through.

Trial Rights Can Be Used in One of These Two Situations:

If you joined a Medicare Advantage plan when you were first eligible at age 65

If you signed up for Original Medicare with a Medicare Supplement plan and decided to switch to a Medicare Advantage plan

Also, if you start out with a Medicare Supplement Plan, and then decide to try out a Medicare Advantage plan you can exercise trial rights within 1 year during the time you switched away from your Medigap plan.

What If You Have Been in a Medicare Advantage Plan for More Than 1 Year?

If you have been in a Medicare Advantage plan for more than a year, you likely do not have a trial right.  You can, still, apply for a Medigap plan.  However, the insurance company can apply for medical underwriting. If you have health conditions, you might either have to pay a higher rate, or you might not be able to get the Medicare Supplement Policy at all. Nonetheless, there are instances that allow you to move from a Medicare Advantage plan to Medigap with guaranteed issue rights.

  1. You lost coverage because you moved out of the Medicare Advantage coverage area.
  2. Your Medicare Insurance Company goes bankrupt, resulting in you losing your coverage.
  3. The company hasn’t followed the rules or has misled you.
  4. Some states have other guaranteed Issue rights periods.  For example, in California, if your Medicare Advantage Plans raises your co-pay, you may have a guaranteed issue right to get a Medicare Supplement Plan.

If you don’t qualify for the Guaranteed issue, you will have to pass underwriting requirements to see if you can qualify for a change in plan.

You may not have to wait for the Annual Enrollment Period (AEP) to use the Medicare Advantage trial rights.  And don’t forget, until you have been approved for your Medigap plan, do not disenroll from your Medicare Advantage Plan.

Image of cartoon character with red phone inviting the reader to call or email MedicareQuick with questions If you are unhappy with your plan and are not sure what to do, we are here to answer your questions and help you decide. Call us today at (866) 445-6683 or drop us a message HERE, for a free consultation.

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