What Are Trial Rights and How Do They Work?

what are trial rights

Picking the right Medicare plan can be a daunting task. You should carefully consider what your needs are and research the available options. Your goal should be to select the best plan for your healthcare situation. But the reality of choosing a Medicare plan isn’t always so simple.

That’s why every Medicare beneficiary has a trial right. And no, we’re not talking about the right to a fair trial should you bend the rules of justice. We’re talking about the right to try a Medicare plan to see if the policy will work for you. Today we’re taking a look at how and when you can exercise your trial right.

Open Enrollment Period (OEP)

First, a quick reminder on your annual opportunity to make changes to your Medicare plan. OEP takes place every year from January 1 through March 31. This is a popular time to alter your Medicare plan because of the many changes beneficiaries can make. Here’s what you can do during OEP:

  • Switch from one Medicare Advantage plan to another Medicare Advantage Plan
  • Disenroll from a Medicare Advantage Plan and return to Original Medicare (with or without a Part D drug plan).

Of course, there are a few things you can’t do during OEP:

  • You CAN’T switch from Original Medicare to a Medicare Advantage Plan
  • You CAN’T add or switch a Medicare Prescription Drug Plan (if enrolled in Original Medicare). 

Special Election Periods (SEP)

SEPs are election periods designed to account for extenuating or unforeseen circumstances, like changing residences, extreme weather or uncontrollable circumstances (like a pandemic). During a SEP, affected beneficiaries can make changes to their coverage. These situations include:

  • Moving into an area where your existing coverage is invalid, whether it’s to a new private residence or into a care facility;
  • Being impacted by an extreme weather event (as defined by FEMA) that causes a temporary or permanent change in residency (this also applies to a caregiver);
  • Being unable to enroll in Medicare because your Initial Election Period fell between March 17 and June 17, 2020 (during the emergence of the COVID-19 pandemic);
  • Changing your primary residence to live with a family member as a result of the COVID-19 pandemic;
  • Losing coverage from an employer or spouse’s employer; or
  • Losing Medicaid coverage.

Not all SEPS are the same, and the length of the SEP depends on the circumstances. For example, changing your residence results in a 60-day SEP whereas a FEMA-designated natural disaster usually has a 120-day SEP.

What about Medicare trial rights?

There is also a SEP for beneficiaries who select a Medicare Advantage plan when they first become eligible for Medicare. When you enroll in a Part C plan, you have a full year to try out the plan. You can drop out of the Medicare Advantage plan at any time during the first 12 months. The only caveat is that if you choose to leave your Medicare Advantage plan, you must replace the plan with a traditional Medicare insurance option.

If you choose to exercise your trial right, you are also eligible for a guaranteed issue right. This means you have the right to purchase a Medigap supplemental plan for up to 63 days after disenrolling from your Medicare Advantage plan.

Every beneficiary should take advantage of their trial rights when they feel they aren’t getting the best possible coverage for their lifestyle. But the process for exercising this right isn’t always easy to navigate. The professionals at My Senior Health Plan are happy to help! Contact My Senior Health Plan today at (877) 255-6273 or visit our website.

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