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.
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