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Medicare offers several options for health coverage, including Original Medicare and Medicare Advantage (Part C). Choosing the right plan can be challenging, especially if you’re trying a Medicare Advantage plan for the first time. Fortunately, Medicare provides trial rights that allow beneficiaries to switch back to Original Medicare under specific conditions. Understanding Medicare trial rights helps beneficiaries make informed decisions and avoid being locked into a plan that may not meet your needs.

What are Trial Rights

Medicare trial rights are special protections. They allow beneficiaries to return to Original Medicare if they are dissatisfied with their Medicare Advantage plan. These rights apply in two primary situations:

Those who enroll in a Medicare Advantage plan when first eligible for Medicare and decide within the first 12 months that it’s not the right fit, can return to Original Medicare. You can also enroll in a Medicare Supplement (Medigap) plan without facing medical underwriting restrictions.

Beneficiaries who had a Medigap plan and dropped it to join a Medicare Advantage plan for the first time, can switch back to Original Medicare anytime within the first 12 months. Additionally, they have the right to re-enroll in the same plan they had previously if it is still available. If it is not, they can purchase a different Medigap plan.

Why are Trial Rights important

Medicare Advantage plans may not always work out as expected. They typically have provider networks, may require referrals for specialists, and can come with different costs than Original Medicare. If the beneficiary’s preferred healthcare providers are not in-network, or the coverage does not suit their healthcare needs, trial rights provide a way to switch back without penalty.

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Understanding how to use a Medicare Trial Right

Those who decide to use the trial right should:

• Contact a Medicare agent, if possible to get the best plan options to fit coverage needs. Those who don’t have an agent; call Medicare at 1-800-MEDICARE or visit Medicare.gov to change their plan back.
• Be sure to apply for a Medigap policy within the 12-month window, if they want supplemental coverage. This helps ensure coverage without going through underwriting.
• Because Original Medicare does not include prescrption drug coverage, it is also important to enroll in a standalone PDP plan.

Things to remember

• Medicare trial rights allow beneficiaries to return to Original Medicare within 12 months of enrolling in a Medicare Advantage plan for the first time.
• Those who switched from a Medigap policy to a Medicare Advantage plan for the first time may be able to reinstate their Medigap policy. If it is not available anymore, they can or get a new one.
• These rights help protect beneficiaries from being stuck in a plan that does not meet their healthcare needs.

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It is important to understand the rights of your clients to ensure they have the flexibility to choose the best coverage for their healthcare needs. If a client enrolls in a Medicare Advantage plan for the first time, explain the time available should they want to go back to Original Medicare. To take advantage of these protections, act within the trial period.

What is a Medicare Trial Right

Because there are so many Medicare enrollment periods, there are some that may get overlooked.  One of the lesser-known  yet significant enrollment opportunities is the Medicare Trial Right. We will go over what a Medicare Trial Right entails, and who qualifies.

When an agent has a client enrolled in a Medicare Advantage (MA/MAPD) plan and they wan to change back to Original Medicare, they may be eligible for a trial right.  If this is the case, they have an opportunity to change their plan without having to wait for the AEP (Annual Enrollment Period). This enrollment period allows beneficiaries a chance to go back to Original Medicare or original Medicare and a Supplement and /or PDP plan.  This gives beneficiaries a way to get the coverage they need if the plan they chose is not a good fit for their current healthcare needs.

How does a Trial Right work

Trail Rights apply to beneficiaries who enroll in a Medicare Advantage plan for the first time. The enrollee has a 12 month time frame to try a MA/MAPD plan. This enrollment period is very similar to the Medicare supplement free look although they each have their own qualifying rules and the time you have to use each one is different.  New MA/MAPD beneficiaries have a Trail Right period of  12-months.  On the other hand, enrollees of Medicare Supplement plans are entitled to a free look period of 30 days.

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Who qualifies for a Trial Right

Beneficiaries Who Enrolled in an MA/MAPD plan when they first signed up for Medicare

It is important to understand the timelines associated with the Medicare Trail Right.  If a beneficiary enrolls in a Medicare Advantage plan during their Medicare Initial Enrollment Period (IEP), they can change to Original Medicare anytime during the first 12 months of enrollment in the Medicare Advantage plan.  Here’s an example: if a client turns 65 and chooses a MAPD plan for November 1st, the trail Right period runs until December 30 of the next year.  This means they can opt to disenroll form the MA/MAPD plan and go back to Original Medicare anytime during those 12 months.

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Medicare Supplement beneficiaries who chose to enroll in a MA/MAPD plan for the first time

When Medicare Supplement plan enrollee decides to try a MA/MAPD plan for the first time.  If they decided they do not like the MA/MAPD plan,  they have 12 months to go back Original Medicare.

Important:  beneficiaries who use the Trial Right can choose to enroll in a PDP plan as well as a Medicare Supplement plan. They do not have to go through underwriting for the Medicare Supplement plan.

Benefits of Medicare Trial Right

1. Flexibility: It provides enrollees the ability to explore Medicare Advantage Plans or switch back to Original Medicare without penalty.
2. Tailored Healthcare: Enables individuals to find the best plan for their healthcare needs, preferences and budget.
3. Peace of Mind: Offers peace of mind in the event the chosen plan doesn’t meet expectations, the beneficiary can change their plan.

What to consider before using the Trial Right

1. Beneficiaries need to understand their current plan, including coverage, costs, and provider network.
2. Research alternatives: Compare coverage, costs, provider networks, and additional benefits.
3. Make an informed decision: Assess healthcare needs, preferences, and budget to determine the best course of action.
4. Enroll in the new plan: Once enrollment in the new plan is confirmed, inform your current Medicare Advantage plan that you are disenrolling.

Other enrollment periods

Please remember, beneficiaries can only use the Trial Right one time.  However, there are several other options that provide an opportunity for a client to change plans.

Learn about other Medicare election periods

Disenroll from a Medicare plan

Enrollees can disenroll from a Medicare Advantage plan by contacting the provider directly or contacting your local Medicare office 1-800-MEDICARE (1-800-633-4227).

Many beneficiaries do not know about the Medicare Trial Right period. It is up to the agent to make sure clients are aware that they have options if they are unhappy. It is always important to be sure the client gets the healthcare they need.

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