If you have a client who enrolled in a Medicare Advantage plan but wants to go (back) to Original Medicare, they may qualify for a Medicare Advantage trial right! This would allow them to update their coverage outside of the Annual Enrollment Period.
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How does the Medicare Advantage trial period work? Keep reading — we’re covering the basics!
What Are Trial Rights for Medicare Advantage?
Medicare Advantage trial rights work similarly to Medicare Supplement free look period rights, but they have different qualifying criteria and a longer time frame associated with them. Essentially, your clients have a 12-month period to test out a Medicare Advantage plan. (With a Medicare Supplement free look period, your client has 30 days to make a decision of whether they’d like to keep their new policy or not.) If they like it, great, they can keep it! If they have buyer’s remorse, they can switch back to Original Medicare and either return to their former Medicare Supplement (if they had one) or pick up a new Medicare Supplement. Permissible actions vary based on client-specific situations and state-specific regulations. (Some states extend the Medicare Advantage trial right period or offer additional Medicare Supplement guaranteed issue rights.)
Essentially, your clients have a 12-month period to test out a Medicare Advantage plan.
Who Has a Medicare Advantage Trial Right?
Two types of clients qualify for trial rights for Medicare Advantage. Let’s explore them below.
1. MA Clients (or PACE members) Who Enrolled Upon Turning 65 & Less Than 12 Months Ago
If you have a client who enrolled in a Medicare Advantage plan upon joining Medicare Part A at age 65, they may switch to Original Medicare as long as they do so within a 12-month period.
Example: Denise enrolls in a Medicare Advantage plan when she turns 65. Her coverage has an effective date of June 1. Her trial period will end on May 30 of the following year.
When using this trial right, your client may pick up a prescription drug plan and any Medicare Supplement available to them in their area without having to pass underwriting. However, they must apply for Medicare Supplement coverage no earlier than 60 calendar days before, and no later than 63 days after, the date their Medicare Advantage coverage ends.
2. Med Supp Clients Who Switched to MA (or Medicare SELECT) for the First Time Less Than 12 Months Ago
What if your client joined a Medicare Supplement plan when they became eligible for Medicare, then decided to try out a Medicare Advantage Prescription Drug plan? If they’d like to return to their previous plan (and Original Medicare), they can do so if their Medicare Advantage effective date is less than 12 months ago.
Example: Bob decided to leave his Medicare Supplement, prescription drug plan, and Original Medicare 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.
In this case, your client will only have the right to rejoin the Medicare Supplement plan they had before the switch. If their previous Medicare Supplement plan is no longer offered (i.e., the insurance company no longer sells it), they may buy a guaranteed issue plan sold by a different company in their state. They must apply for Medicare Supplement coverage no earlier than 60 calendar days before the date their Medicare Advantage coverage will end and no later than 63 days after that date. They can also pick up a stand-alone prescription drug plan.
How Are MA Trial Rights Different Than the MA OEP?
Generally speaking, Medicare Advantage trial rights are for clients who enrolled in a Medicare Advantage plan for the first time ever less than 12 months ago. (Remember, the client’s state may provide additional rights.) Like trial rights, the Medicare Advantage Open Enrollment Period helps people who have recently enrolled in a Medicare Advantage plan switch their coverage if they’re dissatisfied with it. Here’s how the MA OEP works differently than the trial rights:
- The MA OEP allows beneficiaries who join Medicare Advantage upon becoming eligible for Medicare a period of three months after their Part A and B entitlement to switch their coverage.
- The MA OEP also allows beneficiaries who enroll in a Medicare Advantage plan during AEP (plan effective date of January 1) a three-month period (January 1 to March 31) to switch their coverage.
- Clients who qualify for the MA OEP can switch MA plans, switch back to Original Medicare, or pick up or drop Part D coverage. (Trial rights don’t allow Medicare Advantage clients to switch Medicare Advantage plans, only switch back to Original Medicare.)
- Additionally, the MA OEP is not available to those who enroll in Medicare Medical Savings Accounts or other Medicare health plan types, such as cost plans or PACE. (Medicare trial rights apply to MSA plans or PACE members.)
Please note beneficiaries who use the Medicare Advantage Open Enrollment Period will be subject to underwriting for a Medicare Supplement if they do not have a guaranteed issue right. You can read more about the Medicare Advantage Open Enrollment Period here
What If My Client Already Used Their Trial Right?
If your client has already used their Medicare Advantage trial right, they will have to wait until the Annual Enrollment Period, the Medicare Advantage Open Enrollment Period (if they qualify), or another Special Enrollment Period that allows them to make changes to their coverage.
If your client has already used their Medicare Advantage trial right, they will have to wait to make changes to their coverage.
How Can My Client Disenroll from Their Plan?
Your client can leave their Medicare Advantage plan by submitting a request to their plan or calling 1-800-MEDICARE (1-800-633-4227).
The one-year Medicare Advantage trial period is an important right that many Medicare beneficiaries likely don’t know exists. Now that you know more about it, we hope you feel more prepared to continue to advocate for coverage changes your client’s behalf!