Medicare can be structured in two basic ways: Original Medicare or Medicare Advantage. During the initial period of Medicare enrollment, changes are permitted without consideration of your health status. Future changes to the way your Medicare is set up could require medical underwriting—questions about your health that can result in denials of coverage. As such, it’s important to consider both current and future care needs and preferences during the initial setup of Medicare. Because there are so many personal preferences that can affect this decision, the choice between Original Medicare and Medicare Advantage can feel difficult to make.
To ensure you are satisfied with your initial choice, Medicare offers options to make changes within the first year without going through medical underwriting. These are referred to as Trial Rights.
Trial Rights:
- Option 1: If you joined a Medicare Advantage Plan when you turned 65 but aren’t happy with the plan, you have a federally protected right to switch to Original Medicare within the first 12 months. You can also pick a prescription drug plan (part D) and a Medicare Supplement (Medigap) plan without underwriting or risk of refusal. However, you must apply before your 12-month window is up. The Medicare Advantage plan should have the same effective date as Part A and Part B coverage in order to be eligible for this Trial Right.
- Option 2: If you had a Medigap plan that you dropped to sign up for a Medicare Advantage Plan (or Medicare Select Policy) and want to switch back, you have the right to return to the same Medigap plan you had previously enrolled in if the insurance company still sells it. This option is valid as long as you’ve been in the Medicare Advantage policy for less than a year.
These Trial Rights provide some flexibility if the Medicare configuration you first chose doesn’t work for your healthcare needs.
Please note:
- A Trial Right can only be used once, and only within that 12-month window.
- If you are looking to enroll in a Medigap plan and don’t qualify for these Trial Rights, or other Guaranteed Issue Rights, you will likely need to go through medical underwriting to apply for a Medigap plan.
- Finally, once enrolled, your Medigap plan is guaranteed and insurance companies can't cancel it, as long as you pay the premium every month.
Last Revised February 15, 2023
