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Medicare Advantage Trial Rights

By Ed Crowe | General Articles | 0 comment | 27 July, 2023 | 0

Medicare Advantage Trial Rights

Sometimes, despite our best efforts, our clients need to update and change their coverage. Maybe their life or healthcare needs changed since enrolling, maybe they want to return to Original Medicare from a Medicare Advantage plan, or maybe they are just dissatisfied with their coverage. Regardless of the reason, there is a regulation in place for this situation called a Medicare Advantage Trial Right.

What are Medicare Advantage Trial Rights?

Medicare Advantage Trial Rights allow beneficiaries to update their coverage outside of the Annual Enrollment Period. Essentially, clients have a 12-month period to test out a MA plan. If they are satisfied with the plan and coverage at the end of the time period, they can keep the plan. If they are not satisfied, they can revert to Original Medicare and either return to their former Medicare Supplement or choose a new Medicare Supplement. What is permissible is dependent on some client-specific regulations and some state-specific regulations, as some places extend the Medicare Advantage trial right period or can offer additional guaranteed issue rights.

Who Qualifies for Medicare Advantage Trial Rights?

There are two types of clients who qualify.

MA clients who enrolled when they turned 65 (less than twelve months ago)

For example, if your client enrolled in Medicare Part A at the same time as their Medicare Advantage plan, they may switch to Original Medicare as long as that switch occurs within a year of enrollment. When the client uses this trial period, they can also choose a Medicare Part D plan (prescription drug) and a Medicare Supplement plan without having to pass any underwriting, depending on what is available in their area.

Medicare Supplement beneficiaries who switched to a Medicare Advantage plan for the first time less than twelve months ago

If the client chose a Medicare Supplement plan when they first turned 65 but then decided to try out a Medicare Advantage plan, they can still switch back to Original Medicare within the first year of the Medicare Advantage plan coverage. They have to return to their previous plan, however, and do not have the option to purchase a different one. If that insurance carrier no longer offers their previous plan, the client will be able to purchase a guaranteed issue plan offered by a different carrier.