Understanding the Medicare Advantage Trial Period

You have the right to a Medicare Advantage trial period. The trial period gives you a year to try a Medicare Advantage (Part C) plan and see if it’s right for you.

If you decide it’s not, you can switch back to original Medicare (parts A and B) and purchase a Medigap plan. Medigap is also known as Medicare supplement insurance.

Two different situations will allow you to have a trial period:

• You enroll in a Medicare Advantage plan when you’re first eligible for Medicare. If you leave the plan within 12 months, you’ll be able to purchase any Medigap plan available in your area without medical underwriting.
• You leave a Medigap plan and enroll in a Medicare Advantage plan for the first time. If you leave your new Medicare Advantage plan within a year, a special enrollment period will be triggered, and you’ll be able to buy your old Medigap plan again. If your plan is no longer available, you’ll be able to buy any Medigap A, B, C, D, F, G, K, or L plan in your area.

This is important because Medigap plans have medical underwriting standards. That means you can be denied a Medigap plan or charged a much higher premium depending on your health.

However, when you first sign up for Medicare, there’s no medical underwriting for a Medigap policy.

During your initial enrollment period, you’re able to buy any plan in your area and can’t be charged higher rates for any health conditions you have. After this initial enrollment ends, though, you can be denied a Medigap plan — unless you’re buying one after your Medicare Advantage trial period.

For example, let’s say you didn’t enroll in Medigap when you first became eligible for Medicare. Years later, you want to purchase a Medigap plan. You’ve been diagnosed with congestive heart failure (CHF) and diabetes. You might be denied a plan or offered only plans with very high premium rates.

However, let’s say you did choose to purchase a Medigap plan during your initial enrollment. You’d be guaranteed a policy and a good rate. Your diagnosis of CHF and diabetes wouldn’t disqualify you.

You’d also be guaranteed a policy if you chose to enroll in a Medicare Advantage plan when you first became eligible for Medicare but left that plan within 12 months.

When you leave a Medigap plan for a Medicare Advantage plan later on, you have 1 year to switch back to Medigap. You’ll be able to purchase the exact plan you had before if you go back within a year.

In this case, you’d be in a special enrollment period. This is a window of time when you can enroll in or switch your Medicare plans, outside of initial or open enrollment.

However, if you stay in your Medicare Advantage plan for 2 years and then try to switch back, you’ll have to wait for open enrollment. Plus, you might be denied the option to purchase your old plan — or any Medigap plan at all.

The Medicare Advantage trial period doesn’t affect just Medicare Advantage (Part C). It allows you to switch your Medicare plan and put together the Medicare parts that work best for you.

It works with different parts of Medicare in slightly different ways:

• Medicare parts A and B (original Medicare). Medigap plans work with Medicare Part A (hospital insurance) and Medicare Part B (medical insurance), known together as original Medicare. When you switch away from Medicare Advantage during the trial period, you’ll be using original Medicare. Though you can switch back to original Medicare from an Advantage plan when you’re not in a trial period, you won’t be guaranteed a Medigap policy to go along with your original Medicare.
• Medicare Part C (Medicare Advantage). The trial period exists to help you decide if a Medicare Advantage plan or a Medigap plan makes the most sense for you. You can switch to a Medicare Advantage plan during other open enrollment windows, but you won’t qualify for a trial period.
• Medicare Part D (prescription drug coverage). Many Medicare Advantage plans include Part D coverage. If the Medicare Advantage plan you had during your trial period was one of them, you’ll also be able to get a stand-alone Part D plan at this time.

The trial period can impact your cost for a Medigap plan.

The cost of a Medigap plan is affected by factors like your:

• age
• gender
• overall health

When you use the trial period, you’re guaranteed a good rate, even if you wouldn’t normally qualify for one.

For example, if you used the trial period and switched away from your Medicare Advantage plan within your first year of enrollment, your rates for the exact same Medigap plan could be much cheaper than if you changed after 15 months.

All Medicare members are eligible for the Medicare Advantage trial period if they’re new to Medicare Advantage. You’ll also need to be either in your initial enrollment window or dropping a Medigap plan.

The Medicare Advantage trial period has no other time requirements.

If you left your Medigap plan to try a Medicare Advantage plan, you’d enter a trial period, whether you’d been enrolled in Medicare for 3 or 13-plus years.

Conversely, if you were enrolled in original Medicare but not a Medigap plan for 2 years, now want to switch from original Medicare to an Advantage plan, and don’t qualify for a trial period, you would still be able to switch back to original Medicare during open enrollment. However, you wouldn’t be guaranteed the option to purchase a Medigap policy.

You don’t need to enroll to take advantage of the Medicare Advantage trial period. You’ll be automatically enrolled as long as your Medicare Advantage enrollment is eligible for the trial period.

You’ll have 63 days after you leave your Advantage plan to purchase a Medigap plan. You can also purchase a plan starting 60 days before your Medicare Advantage plan coverage ends.

You don’t need to take any additional steps. You can just cancel your Advantage plan and purchase a Medigap plan.

• The Medicare Advantage trial period allows you to try out Medicare Advantage and decide if it’s right for you.
• You’ll have a year to see if the plan works for you. If it doesn’t, you’re able to buy a Medigap plan without any medical underwriting or go back to Medigap if you had it previously.
• The trial period only applies when you first enroll in Medicare or if you’re leaving a Medigap plan to enroll in a Medicare Advantage plan for the first time.