Medicare Advantage Trial Rights: A Safety Net When Leaving Medigap

Why Trial Rights Exist

Medicare Advantage and Original Medicare with Medigap are two different ways of receiving the same Medicare benefits. Advantage plans work through networks, often with lower premiums and extra benefits. Medigap pairs with Original Medicare, pays most of the cost-sharing, and does not use a network. Many people look at the two side by side and cannot be certain which will suit them until they have actually used one.

The trouble is that the two are not equally easy to move between. You can leave a Medigap policy for Advantage whenever you can enroll in a plan. Coming back is the hard direction, because most states let Medigap insurers use medical underwriting when you apply outside of certain windows. If your health has changed while you were in Advantage, an insurer can decline you or charge more.

Congress recognized that people might want to try Advantage without risking their ability to return. The trial right is the answer. It does not tell you which option to choose. It simply makes it less risky to find out.

The Two Types of Trial Right

	Joined Advantage when first eligible at 65	Dropped Medigap to try Advantage
Window	12 months from your Advantage start date	12 months from your Advantage start date
What you may buy	Any Medigap policy sold in your state	The policy you had, if the insurer still sells it
If it is unavailable	Not applicable	Plan A, B, C, D, F or G sold in your state
Application timing	60 days before to 63 days after Advantage ends	60 days before to 63 days after Advantage ends

Medicare’s official guide labels both situations a “trial right.” Insurers and advisors often number them “trial right 1” and “trial right 2,” which is a useful way to keep them straight. Both last 12 months, counted from the date your Medicare Advantage coverage begins.

Trial right for new Medicare enrollees. If you join a Medicare Advantage plan, or a Program of All-inclusive Care for the Elderly (PACE), when you are first eligible for Medicare Part A at 65, and you decide within the first year that you want Original Medicare instead, you have a guaranteed-issue right to buy a Medigap policy. Medicare’s official Medigap guide describes this as being able to buy any Medigap policy that is sold in your state by an insurance company, regardless of your health. The reasoning is straightforward: you never had the chance to try Original Medicare with Medigap, so you get one.

Trial right for people leaving Medigap. If you had a Medigap policy, dropped it to join a Medicare Advantage plan for the first time, and are in that plan for less than a year, you can switch back. You have a guaranteed-issue right to buy back the policy you had before, as long as the same company still sells it. If that policy is no longer available, Medicare’s guide says you can buy one of several standardized plans sold in your state, specifically Plan A, B, C, D, F or G, with a note that Plans C and F are no longer sold to people who became eligible for Medicare on or after January 1, 2020. Ask the insurer exactly which plans it must offer you.

There is a common thread. Both are for people making a first-time move into Advantage, and both end 12 months after the Advantage coverage starts. Medicare’s guide adds that in certain circumstances your rights may last an extra 12 months and tells people to check with their State Insurance Department. States can add protections beyond the federal rule, so ask your state insurance department or State Health Insurance Assistance Program (SHIP) counselor what applies where you live.

How the Deadlines Work

The deadlines are strict, and they trip people up.

• The 12-month clock starts on the date your Medicare Advantage coverage begins, not the date you applied.
• You can start applying for Medigap as early as 60 days before your Advantage coverage is set to end, and you can apply up to 63 days after it ends.
• Federal Medicare Advantage rules give you a Special Enrollment Period to leave during the trial year and return to Original Medicare, so you do not have to wait for the fall or January to March windows. Confirm the exact timing and effective date with the plan or with 1-800-MEDICARE before you submit your request.

Because insurers cannot sell you a Medigap policy that overlaps with Advantage coverage, you want the new policy to start on the same date your Advantage plan ends. Plan this carefully, and ask for the Medigap effective date in writing before you disenroll.

The most common error is losing track of the date. If your coverage began on the first of a month, your trial window ends 12 months later. Mark both dates on a calendar the day you enroll, and consider setting a reminder a few months before the end of the window as well, so you have time to decide.

What the Trial Right Does Not Do

A guaranteed-issue right is powerful, but it is not a promise that everything will return to how it was.

First, it does not freeze your premium. If you are rejoining a policy with the same company, you will generally pay the premium that applies to your age and the policy’s rating method today, not the one you paid years ago. Medigap policies are priced in different ways, such as attained-age, issue-age or community rating, so ask the insurer which method it uses. Our page on Ohio’s Medigap regulations explains how each one affects premiums over time.

Second, it does not guarantee the exact policy you had. If the insurer no longer sells it, you are limited to the list of other plans described above.

Third, it does not extend past 12 months. People sometimes believe they have a “trial” for two years or that the clock restarts if they switch Advantage plans. In general, it does not. The federal enrollment rules we reviewed tie the 12 months to your first Advantage enrollment, so changing from one Advantage plan to another does not typically restart the trial period. Because states can add protections, confirm how your own situation is counted before relying on extra time.

Fourth, it does not work if you do not meet the conditions. A person who has been in Advantage for several years, or who enrolled in Advantage after the first-eligibility point and had no Medigap, does not have a trial right. In that case, a Medigap application in most states would be underwritten unless another guaranteed-issue event applies.

What You Give Up When You Drop Medigap

Before using the second type of trial right, it helps to understand what you would be trading away. A Medigap policy you already hold has some features that are not easy to replace.

A Medigap policy is guaranteed renewable under federal law, meaning the insurer cannot cancel it because of your health or because you filed claims, as long as you pay your premium and did not misrepresent anything on your application. If you cancel it, you give up that continuity. If you later buy a policy under a guaranteed-issue right, you receive a new policy with new protections, and you may have lost a rate history or a premium structure that worked for you.

You also give up the freedom to see any provider that accepts Medicare. Medicare Advantage uses networks, and many plans require referrals or prior authorization. Our posts on checking a plan’s network and how prior authorization works describe what to look for. And your Medigap coverage would end, which means that the trial year is a real change in how your care is paid for, not merely a test drive.

None of this is a reason to avoid trying Advantage. It is simply a reason to treat the year as a decision window with an end date, not as a casual experiment.

Questions Worth Asking Before You Enroll

If you are thinking about using a trial right, or you are in the first months of one, these questions can keep the process on track.

• Which trial right applies to me, and what date does my 12-month window end?
• If I drop my Medigap policy, will my insurer still sell the same plan if I come back?
• What would my premium be under today’s rating rules, compared with what I pay now?
• Are my doctors, specialists and hospital in the Advantage plan’s network, and does it require prior authorization for the services I use most?
• Are my medications on the plan’s formulary, and at what cost?
• What is the plan’s annual out-of-pocket maximum, and how does that compare with the risk of the 20% coinsurance in Original Medicare without Medigap? Our post on Medicare Advantage out-of-pocket maximums helps with that comparison.
• If I leave during the trial, how will the dates line up so there is no gap?

When the Trial Right Is Not Available

Many people reading this will find that the trial right does not apply to them because their Advantage enrollment began years ago. If that is you, the options are described in our post on switching from Medicare Advantage back to Original Medicare. The short version is that other guaranteed-issue events exist, such as your plan leaving the area or ending, but outside of those, Medigap insurers in Ohio can apply medical underwriting.

If you are still in the decision stage and have a choice, the trial right can be part of your thinking. It is a safety net with a firm deadline, and it works best for people who know the date it expires and have checked how the switch back would work in their state.

A Step-by-Step Way to Use a Trial Right

• Step 1: Write down your dates. Note the day your Advantage coverage began and count 12 months forward. That is your deadline for leaving under the trial right.
• Step 2: Identify which trial right applies. Did you join Advantage or PACE when first eligible at 65, or did you drop a Medigap policy to try Advantage for the first time?
• Step 3: Decide early. You can start applying for Medigap 60 days before your Advantage coverage ends. Waiting until the last month leaves little room for errors.
• Step 4: Contact the insurer. If you are rebuying a previous policy, ask whether the company still sells it and what the premium would be under current rules.
• Step 5: Apply and keep proof. Include any proof of your Advantage enrollment dates the insurer requests.
• Step 6: Confirm the start date in writing. The policy must start after your Advantage coverage ends, ideally the same day.
• Step 7: Handle Part D. If your Advantage plan included drug coverage, choose a standalone drug plan that begins when Advantage ends.
• Step 8: Disenroll and verify. Request disenrollment, get the effective date in writing, and confirm that your Medigap and drug coverage begin as planned.

Three Scenarios

These are hypothetical.

Picture a retiree who dropped Medigap to try an Advantage plan with a low premium. Eight months in, their specialists are out of network. They are inside the 12-month window, so they contact the company that issued their old policy. If the company still sells it, they can buy it back without health questions.

Picture someone who turned 65 and chose Advantage as their first coverage. They discover at month ten that they would prefer Original Medicare. Because they joined when first eligible, they can buy any Medigap policy sold in their state, and the main task is applying inside the window.

Picture someone in month fourteen of an Advantage plan. They had a Medigap policy before and dropped it. The trial has ended, so no guaranteed right applies on that basis. They may have another right if the plan is leaving the area, but otherwise Medigap would involve underwriting in Ohio.

Mistakes That Cost People the Right

• Counting from the wrong date. The clock runs from the start of Advantage coverage, not from the day you applied.
• Assuming a plan change resets it. Switching from one Advantage plan to another generally does not restart the 12 months.
• Waiting for a bad month. People often wait for a major problem before acting. By then the window may have closed.
• Forgetting drug coverage. Leaving Advantage without a drug plan can lead to a gap.
• Not asking the old insurer early. The insurer’s current rates and available plans may differ from what you remember.

What to Do If It Goes Wrong

If an insurer refuses to sell you a policy you believe you have a right to buy, keep the refusal in writing and contact your State Insurance Department, as Medicare’s guide suggests for people denied in guaranteed-issue situations. Your State Health Insurance Assistance Program can help you check whether your situation qualifies. If the 12 months have passed, ask whether another guaranteed-issue event applies, such as a plan leaving the area or a significant network change, since those rights are separate from the trial.

Frequently Asked Questions

What is a Medigap trial right?

It is a federal protection that gives you 12 months to try a Medicare Advantage plan. If you leave during that year, you have a guaranteed-issue right to buy a Medigap policy without medical underwriting. It applies if you joined Advantage when first eligible at 65 or dropped Medigap to join Advantage for the first time.

How long do I have to use it?

The window is 12 months from the date your Advantage coverage began. You can apply for Medigap as early as 60 days before your Advantage coverage ends and up to 63 days afterward.

Can I get the same Medigap plan back?

If you dropped a Medigap policy to try Advantage, you generally have a right to buy that same policy back if the insurer still sells it. If not, you can buy Plan A, B, C, D, F or G sold in your state, with limits on Plans C and F for people who became eligible for Medicare after 2019. Ask the insurer what it must offer.

Does changing Advantage plans restart the trial?

Generally no. The 12 months run from the date you first joined Advantage, not from the date of each later plan change. Confirm with your state insurance department how your own dates are counted.

Is the trial right the same in every state?

The federal rule is the same everywhere, but some states have added protections or have different rules for plans and rates. Check with your state insurance department or State Health Insurance Assistance Program.