I’m sitting here watching television informercials in the midst of a global health pandemic.
Most of the products seem gimmicky and fake. However, almost all of the companies offer the buyer a free trial offer and/or a money-back guarantee.
Well, most people don’t know that Medicare also has a trial period.
The Medicare Advantage “Trial Period” allows people who enroll in a Medicare Advantage plan when they are first eligible for Medicare Part A at age 65 receive a 12-month period to try out a Medicare Advantage plan. If you’re unhappy with the plan for any reason you can disenroll from the plan and return to Original Medicare. Once you go to Original Medicare, you have a “guaranteed issue right” to purchase a Medigap supplemental plan. You can’t be refused coverage or asked to pay a higher premium by the Medigap insurance plan. You also get a special enrollment period to join a Part D prescription drug plan.
It’s true that Medicare Advantage plans aren’t always a good fit for everyone. Some people like being able to choose their own health care providers rather than be constrained by a Medicare Advantage plan’s network. Others don’t want the hassle of keeping up with the plan changes every year.
That’s why having a “trial period” is so beneficial. It allows you to try out a plan for up to 12 months and you are no obligation to stay with it. And all the while, the “trial period” guarantees you an opportunity to purchase a Medigap supplemental plan and no medical underwriting is involved.
Let’s look at how the “trial period” works in two situations.
•Trial Right No. 1: George joins a Medicare Advantage plan when he was first eligible for Part A at 65, and within the first year of joining, he decides to switch to Original Medicare.
Action: George is provided a “guaranteed issue right” to join any Medigap supplement available in his state. George can switch to a Medigap plan anytime within the first 12 months. He must apply for Medigap coverage as early as 60 calendar days before the date his coverage will end, but no later than 63 calendar days after his coverage ends.
•Trial Right No. 2: George’s wife, Gayle was enrolled in a Medigap supplement and then left her supplement to join a Medicare Advantage plan for the first time. Now that she has been in the Advantage plan for less than a year, she wants to switch back to a Medigap.
Action: Gayle has the right to return to the same Medigap policy she had prior to joining the Advantage plan. If her former Medigap policy is no longer in existence, she is permitted to join. A, B, C, D, F, G, K or L (Remember that Medigap Plan C and Plan F will no longer be accepting enrollments starting in 2020).
Gayle can apply for a Medigap as early as 60 calendar days before the date her coverage will end, but not later than 63 calendar days after her coverage ends.
Important: Plans C and F will no longer be available to people who are new to Medicare on or after Jan. 1, 2020. However, if you were eligible for Medicare before January 1, 2020, but not yet enrolled, you may be able to buy Plan C or Plan F. People eligible for Medicare on or after January 1, 2020 have the right to buy Plans D and G instead of Plans C and F.
Some states have more generous laws with regard to guaranteed issue rights. It’s wise to check with your state insurance department regarding their Medigap rules. it’s always best to apply for a Medigap policy before your current health coverage ends. You can apply for a Medigap policy while you are still in your Advantage plan and choose to start your Medigap coverage the day after your Advantage plan ends. There are several ways to disenroll from a Medicare Advantage plan. Calling (800) MEDICARE or contacting the plan directly are probably the most frequently used.
Remember if your outside of this 12 month “trial period,” you may be subject to medical underwriting. In the previous examples, both George and Gayle have the Annual Enrollment Period (Oct. 15 to Dec. 7) or the Medicare Advantage Open Enrollment Period (Jan 1 to March 31) to switch to Original Medicare. However, they may lose their guaranteed issue rights. The Medigap insurer could charge more, delay or even deny coverage. If you must go through medical underwriting to see if you qualify for a Medigap plan, do NOT disenroll from your Medicare Advantage plan until you receive notification that you have been approved for a Medigap plan.
Your rights to buy a Medigap policy vary by state. A few states have more generous guaranteed issue rights. For example, beneficiaries in New York have a guaranteed issue right year-round (called a continuous open enrollment period) to get a Medicare Supplement policy. However, there are specific times for dropping an Advantage plan — the Annual Enrollment Period, Oct. 15 to Dec. 7, and the Medicare Advantage Open Enrollment Period, Jan. 1 to March 31. In the state of Maine, the “trial period” has been extended from one to three years.
The 2020 “Choosing a Medigap policy” has been updated by Medicare (February 2020). For an on-line copy of this publication visit: https://www.medicare.gov/Pubs/pdf/02110-medicare-medigap-guide.pdf
You can also contact Medicare at 1-800-MEDICARE (1-800-633-4227), TTY users can call 1-(877) 486-2048
Medicare’s website is www.medicare.gov.
Joel Mekler is a certified senior adviser. Send him your Medicare questions at firstname.lastname@example.org.