What Are Medicare Advantage Trial Rights?
When it comes to Medicare, making the right choice about your coverage can feel overwhelming. That’s why Medicare includes special protections, known as “trial rights”, to give beneficiaries a chance to try certain plans without the fear of being stuck with them long-term. Whether you're new to Medicare or trying out a Medicare Advantage plan, these rights can be a lifeline if you decide your current plan isn't working for you.
So, what exactly are Medicare trial rights, and how do they work? Let’s take a deeper look!
Understanding Trial Rights
Medicare trial rights are special protections that allow enrollees to switch from a Medicare Advantage Plan (Part C) to Original Medicare and purchase a Medigap (AKA Medicare Supplement) policy without being denied coverage or charged more due to health conditions. Normally, Medigap policies are medically underwritten, meaning your acceptance isn't guaranteed unless you're in a protected period like your Initial Enrollment Period, your Medigap “Open Enrollment Period” (the six month period that begins the first of the month in which you pick up Medicare Part B), or one of these trial right situations.
Two Key Situations Where Trial Rights Apply
You're new to Medicare and choose a Medicare Advantage Plan first.
If you joined a Medicare Advantage plan when you were first eligible for Medicare Part A and, within the first year of joining, you want to switch to Original Medicare, you may do so as long as it’s within 12 months of joining the Medicare Advantage plan.
As long as you’re within the first 12 months of joining the Medicare Advantage Plan, you have the right to:
Return to Original Medicare,
Pick up a Prescription drug (Part D) plan and
Buy ANY Medigap policy available in your state without medical underwriting. Note: this protection is available even if you didn’t have a Medigap plan before.
Example: Cynthia enrolls in a Medicare Advantage plan when she turns 65. Her coverage has an effective date of April 1. Her trial period will end on March 31st of the following year. Prior to March 31st of the following year, she can return to Original Medicare, pick up a Part D Rx plan, and buy any Medigap policy in her state without medical underwriting.
You dropped a Medigap policy to try a Medicare Advantage Plan for the First Time.
If you joined a Medigap (AKA Medicare Supplement) plan when you became eligible for Medicare and decide you want to enroll in a Medicare Advantage Plan, you have a 12 month period to “try it out”. If you decide Medicare Advantage is not a good fit, you have the option to change back to the SAME Medigap policy that you had before, as long as it’s within 12 months of joining the Medicare Advantage plan.
As long as you’re within the first 12 months of joining the Medicare Advantage Plan, you have the right to:
Return to Original Medicare
Pick up a Prescription drug (Part D) plan and
Rejoin the same Medigap plan you had before the switch. If your previous Medigap plan is no longer offered (e.g. the insurance company no longer sells it), you may buy a guaranteed issue plan sold by a different company in your state.
Example: Thomas decided to leave Original Medicare, his Medigap plan, and his prescription drug plan for a Medicare Advantage Prescription Drug plan during the Annual Enrollment Period. His new coverage has an effective date of January 1. His trial period will end on December 31 of the following year. Prior to December 31st of the following year, he can return to Original Medicare, pick up a Part D Rx plan, and rejoin the same Medigap plan he had before he switched to the Medicare Advantage plan.
Why Trial Rights Matter
When it comes to Medicare, there’s no one-size-fits-all solution. What works well for one person may not be the best choice for someone else. That’s why trial rights are so important; they give you the flexibility to explore your options and find the coverage that truly fits your healthcare needs and lifestyle.
If you want to try a Medicare Advantage plan for the first time, trial rights provide a kind of “safety net.” They allow you to test a plan and, if you decide it’s not meeting your expectations - whether due to provider networks, coverage, or out-of-pocket costs - you have the opportunity to make a change.
Specifically, trial rights let you switch back to Original Medicare and apply for a Medigap (Medicare Supplement) policy without worrying about being denied coverage based on your health history. This is important because outside of certain protected windows like this, Medigap plans may require medical underwriting (medical questions) and aren't always guaranteed to accept your application.
Ultimately, trial rights are about giving you peace of mind. They ensure that your first Medicare choice doesn’t have to be your final one, helping you land on the coverage that fits you best.
Summary
Making Medicare choices can feel like a big commitment, but Medicare trial rights are there to give you peace of mind. If you're thinking about switching from a Medigap policy to a Medicare Advantage Plan or trying a Medicare Advantage Plan for the first time, understanding your trial rights is crucial.
Need help figuring out whether you're eligible or deciding which plan is right for you? As a licensed Medicare broker, I’m here to help you navigate your options with confidence. Have questions? Contact me today for a no-cost consultation!
are Compass is an independent insurance agency that helps seniors navigate the complexities of Medicare and other Senior Products. Our services are offered at NO COST! Care Compass is proudly owned and operated in Blair County, Pennsylvania. We provide Medicare insurance assistance to the residents of Altoona, Hollidaysburg, Duncansville and the surrounding region. If you need assistance with Medicare, contact Care Compass today!
