Take Advantage Of This Medicare Advantage Feature: Test It First

When it’s time to buy a new car, what is one of the first things most people do? Take a test-drive and try out the model to see if it’s what they really want.

When it’s time to tackle Medicare, there is also a chance to test how Medicare Advantage will work. Unlike test-drives however, there are just two trial periods and only one can apply to any beneficiary.

Electing Medicare Advantage During the Initial Enrollment Period (IEP).

The official name for this trial period (in the CMS Managed Medicare Manual) is the Special Enrollment Period for Beneficiaries age 65, abbreviated SEP65. It applies to those who elect Medicare Advantage during their IEP (the seven-month window around the 65^th birthday). At any time during the first 12 months in which the plan is in effect, beneficiaries can:

• disenroll from, or drop, the plan
• return to Original Medicare Part A and Part B
• enroll in a stand-alone Part D drug plan, and most importantly
• have a guaranteed issue right to purchase any Medigap policy (Medicare supplement insurance) that is sold in their state.

One example: A client’s 65^th birthday was December 30, 2024. After getting his Medicare card in January, he enrolled in a Medicare Advantage plan. His trial period began February 1 and will end January 31, 2026. He experienced buyer’s remorse in July. With the SEP65 trial period, he can drop the plan, effective September 30 and Medicare coverage will begin October 1.

Dropping a Medigap Policy to Enroll in a Medicare Advantage Plan.

The second trial period is for those who initially chose Original Medicare with a Medigap policy and Part D drug plan. They will also have a 12-month period to try out Medicare Advantage, which begins on the month the plan takes effect.

Pay attention to these details.

• After disenrolling from the Advantage plan, the beneficiary will return to Original Medicare Part A and Part B, and can get a drug plan.
• There is a guaranteed issue right to get the same Medigap policy that was in effect before the change.
• If the former policy is no longer available, the beneficiary can buy a Medigap policy (Plan A, B, C, D, F or G) sold by a state insurance company.

Last month, a former client emailed me.

“Diane, I think I made a mistake. After two years with a Medigap policy, I opted to switch to a Medicare Advantage plan. I read about a trial period so I am wondering whether there is a path to get back my Medigap without medical underwriting.”

The big question: When did her Medicare Advantage plan take effect? The answer: April 1, 2024. Unfortunately, her trial period ended March 31, 2025. As with the SEP65, this period is only 12 months. Because she didn’t act in time, she has no guaranteed issue right to get a Medigap policy so she will likely face medical underwriting.

Important Points about Trial Periods

• Only one of these trial periods will apply to any beneficiary, depending on whether the person is enrolling in Medicare at age 65 or later.
• When the available trial period expires, that’s it. No more test drives.
• There are several ways to disenroll from a Medicare Advantage plan, according to Medicare.gov.
  • Call 1-800-MEDICARE.
  • Mail or fax a signed written notice to the plan.
  • Submit a request to the plan online, if that option is available.
  • Call the plan and ask for a disenrollment notice to complete, sign and send back to the plan.

Enrolling in a stand-alone Part D drug plan can also work in most situations.

• Do not set the disenrollment date until confirming the start date of the Medigap policy. An insurance company cannot sell a policy to someone with an Advantage plan but an application can be made before the plan is discontinued to ensure there is no gap in coverage.
• If failing to disenroll before the 12-month deadline, the next opportunity will be during either the Open Enrollment Period, October 15-December 7, or the Medicare Advantage Open Enrollment Period, January 1-March 31. Because there is no guaranteed issue right, insurers can appy medical underwriting and the Medigap application could be denied.
• There are no trial periods for those who delay Medicare coverage until retirement after their IEP and then enroll in a Medicare Advantage plan.
• Check with your state insurance commissioner to learn about any unique twists in your state. For example,Wisconsin has a “special state trial period” for those who retire from employer-sponsored coverage to enroll in a Medicare Advantage plan.

The trial periods for Medicare Advantage provide some flexibility. But you must be aware of the the specifics, especially the 12-month deadline. Make Medicare Advantage work to your advantage.