The Medicare trial period gives a person 12 months to decide whether their Advantage plan is the right choice for them.
During the trial period, a person generally retains access to Medigap, which means that they can potentially reenroll in a Medigap plan without medical underwriting and that Medigap cannot deny them a new Medigap policy. However, there are some exceptions.
At the end of the trial period, a person can choose to stay with the Advantage plan or return to original Medicare and a Medigap plan.
Federally funded Medicare provides health insurance for people aged 65 years and older and some younger people with certain conditions or disabilities.
The Medicare program consists of four parts:
- Part A is hospital insurance.
- Part B provides medical coverage.
- Part C, also called Medicare Advantage, offers the same coverage as original Medicare (Part A and Part B) and may offer additional benefits, such as hearing, dental, and vision care.
- Part D covers prescription drugs.
In addition, a person can choose to get a Medigap plan, which is Medicare supplemental insurance. These plans help reduce the out-of-pocket costs of original Medicare (parts A and B) with the exception, since 2020, of the Part B deductible.
Private insurance companies administer Medigap plans, which are only available to people enrolled in original Medicare. A person with a Medicare Advantage plan cannot also have a Medigap plan.
When a person is eligible for Medicare, they can enroll in original Medicare and a Medigap plan or choose a Medicare Advantage plan. A person may be eligible for a 12-month trial period, during which they can decide whether an Advantage plan is the correct choice for them.
A person will be eligible if they enrolled in a Medicare Advantage plan when they were 65 years old or initially enrolled in original Medicare and Medigap but then decided to switch to a Medicare Advantage plan.
A person can only use the trial period when they first drop, or disenroll from, Medigap or an Advantage plan.
During the trial period, a person can drop the Advantage plan at any time or reenroll in original Medicare.
If a person decides to rejoin original Medicare, they can also get a Medigap policy. Medigap cannot deny them coverage because they have a guaranteed issue right to get a Medigap policy. However, there may be some conditions.
Medigap protections are known as guaranteed issue rights (GIRs), and they ensure that, in certain situations, a person cannot be denied a Medigap policy. In addition, the Medigap plan provider must cover all of a person’s existing health conditions and cannot charge more for the policy because of present or past health conditions.
The GIR is applicable in several situations, including during a person’s 12-month Advantage trial period.
Other situations in which a person can use a GIR include those when they:
- are enrolled in original Medicare and also have an employer group plan that is ending
- have original Medicare and a SELECT policy and are moving out of the area that the SELECT plan covers
- enrolled with the Programs of All-Inclusive Care for the Elderly (PACE) during the year they turned 65 and then decided to change to original Medicare (the switch to original Medicare must be within the first 12 months of a person’s initial enrollment in Medicare)
- are enrolled in a Medigap plan, and the plan provider declares bankruptcy
- have a Medigap plan policy that ends through no fault of the person
- feel as though a Medigap or Medicare Advantage plan provider misled them or did not follow the rules
During the trial period, a person can choose whether to stay with an Advantage plan or enroll in original Medicare and a Medigap plan.
In the latter case, a person’s choice of Medigap plan may be dependent on whether they initially enrolled in original Medicare and a Medigap plan, or in an Advantage plan.
Original Medicare and Medigap
If a person initially enrolled in original Medicare and a Medigap plan, switched to an Advantage plan during the 12-month trial, then decided to reenroll in original Medicare and Medigap, they may be able to reenroll in their original Medigap plan.
However, if that plan is not available, a person can choose from several other Medigap plans, including A, B, C, D, F, G, K, or L, if the plans are available in their location.
If a person initially enrolled in an Advantage plan but decided during their 12-month trial period to drop the Advantage plan and enroll in original Medicare and a Medigap plan, they can enroll in some Medigap plans. These include plans A, B, C, D, F, G, and K, as long as providers are offering them in the person’s location.
If a person chooses to drop their Advantage plan during the 12-month trial period, they can enroll in a Medigap policy during a special enrollment period (SEP).
Generally, there are only specific times during the year when a person can switch their Medicare plans. However, SEPs are available to a person during their 12-month trial period, which means that they do not have to wait for any other Medicare enrollment periods before making changes.
In addition, SEPs are available in the event of certain situations, such as:
- A person is working, and an employer plan covers them until after the age of 65 years.
- A person moves to an area where their plan is not available.
- A person moves to a skilled nursing facility.
- A person develops a chronic health condition.
Other enrollment periods
There are several times during the year when a person can enroll in Medicare or make changes to their healthcare coverage. In addition to SEPs, these periods include:
- initial enrollment period (IEP)
- general enrollment period (GEP)
- open enrollment period (OEP)
When a person is eligible for Medicare, they can enroll in various healthcare plans, including original Medicare, Medigap, and Medicare Advantage. A 12-month Medicare trial period enables a person to determine whether a certain plan fits their healthcare needs without incurring any penalties.
The trial period is part of the Medicare guaranteed issue rights, which allow a person to change plans without going through medical underwriting.
Medicare has specific times during which people can join or leave Medicare plans. People with special circumstances may have an SEP. People who are eligible can join Medicare plans without a penalty or underwriting during their SEP.