Regret Your Move to Medicare Advantage? Two 'Safety Nets' Can Help: But Act Fast

For many retirees, the decision to drop a trusted Medigap policy for a lower-premium Medicare Advantage plan feels like a high-stakes gamble. What if your favorite specialist is out-of-network, or the copays for a sudden illness stack up? If you’ve made this switch for the first time, the federal government provides a vital safety valve known as Medigap Trial Right #2. This 'undo' button gives you 12 months to test-drive a private plan with the legal guarantee that you can return to your previous Medigap coverage if it doesn't fit.

However, once that 12-month clock expires, the path back to original Medicare becomes significantly more treacherous in most states, turning a simple coverage change into a potential "Medigap Trap".

Safety net 1: Trial right #2 — "the buyer's remorse" reversal

This applies to people who had a original Medicare and a Medigap policy, dropped it to try Medicare Advantage, and then regretted it. This trial right is different than the trial right for those new to Medicare. Pay attention to the different rules; you don't want to make decisions based on rights you may not have. The Advantage Plan has an effective date of January 1st, and the trial right period will end on December 31 of that year.

From just $107.88 $24.99 for Kiplinger Personal Finance

Become a smarter, better informed investor. Subscribe from just $107.88 $24.99, plus get up to 4 Special Issues

CLICK FOR FREE ISSUE

Sign up for Kiplinger’s Free Newsletters

Profit and prosper with the best of expert advice on investing, taxes, retirement, personal finance and more - straight to your e-mail.

Profit and prosper with the best of expert advice - straight to your e-mail.

Sign up

This right gives you a legal "undo" button. If you decide you don't like the MA plan within that first year, you get the right to return to original Medicare. You can disenroll from your MA plan and go back to the "red, white, and blue" card.

You also have some guaranteed issue for Medigap; this is the big one. You have a legal right to buy a Medigap policy without a health screening (no medical underwriting). The insurance company cannot deny you or charge you more because of your health.

Since most Medicare Advantage plans include drug coverage and Medigap plans do not, leaving your MA plan would leave you without drug coverage. Trial Right #2 also grants you a Special Enrollment Period (SEP) to join a standalone Medicare Part D plan so you don't face a late-enrollment penalty.

• Who is Eligible: You dropped a Medigap policy to join a Medicare Advantage plan for the first time, and you have been in that MA plan for less than 12 months.  
• The Right: You can disenroll from the MA plan and return to original Medicare.  
• The Amount/Benefit: You have the right to get your old Medigap policy back from the same insurance company, if they still sell it. 

Which Medigap Plan Can You Get?

• Your old plan: You have the right to get your exact same Medigap policy back from the same insurance company you had before, provided they still sell it.
• A "designated" alternative: If your old company no longer sells that specific plan, you have a guaranteed right to buy Plans A, B, D, G, K, or L from any company in your state. (If you were eligible for Medicare before 2020, you can also choose Plans C or F).

Key rules to remember when exercising your "trial rights"

• The 12-month clock: Both rights expire exactly 12 months after your Medicare Advantage coverage began.
• The application window: 
  • Earliest: You can apply for your Medigap policy as early as 60 days before your Medicare Advantage coverage ends.
  • Latest: You must apply no later than 63 days after your Medicare Advantage coverage ends.  
• Drug coverage: If you leave an MA plan that included drug coverage, you also get a Special Enrollment Period to join a standalone Medicare Part D prescription drug plan.

Safety Net 2: The Medicare Advantage open enrollment period — January 1 – March 31

Since we are currently in March, you are in the final weeks of the Medicare Advantage Open Enrollment Period (MA OEP). This window, which closes on March 31, allows anyone currently enrolled in an Advantage plan to leave it and return to original Medicare.

What you can do: You can leave your MA plan and return to original Medicare.

The Catch: While you can easily return to original Medicare and add a Part D drug plan, getting a Medigap plan is trickier if you are outside your first-year trial right. In most states, if you've been in an MA plan for more than a year, a Medigap insurer can put you through "medical underwriting" and potentially deny you coverage or charge you more due to preexisting conditions.

Exceptions: Only four states — Connecticut, Massachusetts, Maine and New York — prohibit insurers from denying a Medigap policy to eligible applicants, including people with pre-existing conditions.

How to make the switch

Step 1: Secure the Medigap policy

Before touching the MA plan, the reader must apply for a Medigap policy.

Using trial rights: If you are using Trial Right #2, you should inform the insurer of your "Guaranteed Issue Rights" status. You may need to provide proof, such as a letter showing when you first joined the MA plan.

No trial rights: If you are past the 12-month mark (and not in a protected state like NY), you are subject to medical underwriting and must wait for the Medigap insurer to approve your application before moving to Step 2.

Step 2: Choose a stand-alone Part D plan

Since Medigap does not cover prescription drugs, and original Medicare only covers Part A and B, you will need a separate Part D plan.

Using trial rights: Federal law provides a Special Enrollment Period specifically for this "trial" scenario. This allows you to join a standalone Part D plan even if it’s not the standard open enrollment season. When applying for the new Part D plan, you simply check the box stating you are "enrolling because you are using a trial right to leave a Medicare Advantage plan."

Because this is an official SEP, you will not be charged a Part D late-enrollment penalty for the time you spent in the Medicare Advantage plan.

No trial rights: Simply enrolling in a standalone Part D plan during the MA Open Enrollment Period (January 1 – March 31) will automatically trigger a disenrollment from their Medicare Advantage plan. This is often the "cleanest" way to switch.

Step 3: Formal disenrollment (if needed)

If you aren't joining a Part D plan (because you have drug coverage through a former employer or the VA), you must manually disenroll from your MA plan. You can do this by:

Calling 1-800-MEDICARE: This is the most direct method. When an agent answers, state that you wish to disenroll from a Medicare Advantage plan. Once the Medicare systems confirm the disenrollment, which should take approximately 1 week, a confirmation letter will be mailed to you.

Sending a written request: They can mail or fax a signed disenrollment notice directly to the private insurance company.

Step 4: The effective date

Timing is everything. Coverage in original Medicare begins the first day of the month after the request is made.

Make the switch before your trial right or enrollment period expires

If you are currently in the midst of the Medicare Advantage Open Enrollment Period (January 1 – March 31) and weighing a return to original Medicare, timing is everything. For those within their first year, Trial Right #2 is your golden ticket back to guaranteed coverage.

For everyone else, the move requires a 'look before you leap' approach: contact Medigap insurers first to see if they will accept you and at what price. Whether you are protected by federal trial rights or navigating the medical underwriting process, securing your Medigap and Part D drug coverage before disenrolling from your current plan is the only way to ensure your health — and your retirement savings — remain protected.

Read More

• We're Retired With $4.6 Million. My Wife Chose Our Medicare Advantage Plan for the $0 Premium, But I Want Original Medicare’s Freedom. Is It Too Late?
• Quiz: Do You Know How to Avoid the 'Medigap Trap?'
• The Average Retirement Withdrawal Rate by Age