Medicare trial rights are provisions designed to allow beneficiaries to try different Medicare plans without long-term consequences. They come in two different forms. Let’s delve into the details of these rights.
1. Trial Right for New Medicare Beneficiaries Turning 65:
- Eligibility: Clients turning 65, with their Part A and Part B effective dates aligning with their initial eligibility.
- Duration: They get a 1-year trial right upon signing up for a Medicare Advantage plan during their initial election period (IEP).
- Details:
- They can leave the Medicare Advantage plan anytime during the first year. Upon exit, they can enroll in a Medicare Supplement and Part D drug plan effective from the next month, without answering health questions. This makes testing a Medicare Advantage plan low risk.
- After the first year in the Medicare Advantage plan, they can only leave during the Open Enrollment Period (OEP: January 1 to March 31) or the Annual Enrollment Period (AEP: October 15 to December 7). Health questions may be required afterward, and they could face higher rates or denial.
- If using this trial right, beneficiaries should request a coverage review two months before turning 66.
- The trial right also offers flexibility in choosing benefits. If a client passes the health review, they can continue with the Medicare Advantage or revert to their original Medicare supplement.
2. Trial Right for Those Dropping a Medicare Supplement:
- Eligibility: Clients who’ve never had a Medicare Advantage plan but decide to drop their Medicare Supplement to try one.
- Duration: They get a 1-year trial right.
- Details:
- Enrollment in the Medicare Advantage plan should be during the Annual Enrollment Period (AEP: October 15 to December 7). Concurrently, they must ensure the cancellation of their Medicare Supplement by January 1.
- Like the first right, beneficiaries can leave the Medicare Advantage plan during the OEP or AEP. On exit, they can revert to their previous Medicare Supplement without health questions.
- If their old Medicare Supplement isn’t available, they’re guaranteed a supplement from any company, potentially even at lower rates.
- It’s termed as the “two-step” – first step into a Medicare Advantage plan and then step back to the original supplement.
- After the first year, leaving the Medicare Advantage plan is limited to the OEP or AEP, and health questions will be reintroduced. Denials or increased rates may apply.
- If utilizing this trial right, a coverage review is recommended in September. If clients can’t pass the health review, they might remain with the Medicare Advantage plan indefinitely. Successful health reviews grant flexibility between plans.
Key Takeaways:
Both trial rights offer opportunities for beneficiaries to experience the benefits of a Medicare Advantage plan, like acquiring hearing aids not covered by traditional Medicare and supplements. However, it’s essential to be mindful of the durations, conditions, and potential implications of switching.