Today's topic is understanding the Advantage Plan 12 month trial period. Approximately half of all Americans going on Medicare choose an Advantage plan for their Medicare benefits. While most of them hear about the 12-month Advantage Plan trial period, many either don’t know what it means or don’t know how to take advantage of it. That’s why today, we’re going to clear up any confusion you might have about the trial period.  We’ll do this by answering three main questions about the Advantage Plan 12 month trial period. Let’s get started.  

Why Is There a Trial Period?

Medicare Advantage plans originated back in 2003. They offered (and still do offer) several marketable perks that make them attractive to buyers. Some of the bonuses of choosing an Advantage plan include very low (or zero) monthly premiums and perks like dental, vision, gym membership, and hearing aid benefits. 

While there are several perks that come with Advantage plans, there are also a few problems. 

Limited Network

The first problem with Advantage plans is the limited network of providers available on the plan. If you go with an Advantage plan, you will only be able to visit doctors and hospitals within either an HMO or PPO network (depending on the specific plan you choose). This can greatly limit your choices when it comes to health care providers and services, which is why Advantage plans are not for everyone. 

Pre-Certification Process

The second issue with Advantage plans is the pre-certification process. Let’s say you have an Advantage plan and your doctor says you need a knee replacement surgery or some type of test, like an MRI or CAT scan. Before you can get the procedure or test done, it will have to be approved by the Advantage plan. Sometimes they approve procedures and other times they don’t. So just because your doctor says you need a test/surgery/procedure, doesn’t mean you’ll end up getting approved for it by the Advantage plan. This is another reason why Advantage plans are not for everyone. 

In an effort to ensure people are comfortable with things like the limited network and pre-certification process of the Advantage plans, Medicare gives everyone going on an Advantage plan a 12-month trial period to essentially test the plan out. If you develop a health condition after the 12-month trial period, you may be permanently stuck in the Advantage plan. This is why it’s important to take advantage of the 12-month trial period and, if you’re unhappy with the plan, switch to a new plan within the first 12 months. 

When Does the Trial Period Begin?

There is only one instance when you will be guaranteed an Advantage plan trial period. If you miss this window of opportunity, you may not get another trial period, depending on your state laws and insurance carrier’s policy. The best way to show you the one (and only) instance in which all Advantage plan buyers get a trial period is to use an example. 

Let’s say John Smith is turning 65 and retiring in January of 2021. He is going to enroll in Medicare A and B (you have to enroll in both A and B to get an Advantage plan) in January of 2021, the same month he turns 65 and retires. In this situation, John Smith is guaranteed to have a 12-month Advantage trial period because his A and B effective dates are the same as his 65th birthday month. During these 12 months, which last until January 1, 2022, John can get off his Advantage plan and return to original Medicare, without having to worry about going through any medical underwriting. In other words, he can switch and go with any Supplemental plan he wants, and they will have to take him, regardless of any pre-existing health conditions he might have. 

Now let’s look at a different example. John’s wife, Jane Smith, turned 65 in January of 2021. She, unlike John, is not going to retire. Instead, she’s going to keep on working. She does, however, enroll in Medicare Part A (only) when she turns 65. One year later she decides to retire and go on Medicare, which means she’ll now enroll in Medicare Part B. Remember, you have to be enrolled in both A and B to get an Advantage plan. 

Jane is now eligible to get on an Advantage plan, but because her Part A and B effective dates are different (her Part A is January 1, 2021, and Part B is January 1, 2022), she will not have an Advantage trial period. This means even if she gets on an Advantage plan on her Part B effective date of January 1st, 2022, she will have to go through medical underwriting if she ever wants to switch to original Medicare and a Supplemental plan later down the road. 

Again, if you turn 65 and enroll in Medicare A and B right away, you will be eligible for the 12-month Advantage trial period, but if you wait to enroll, you may not be. While each insurance company and state will have different rules about the trial period if you miss the initial enrollment at 65, don’t be surprised if your Advantage company doesn’t give you a trial period. 

What Happens After the Trial Period Ends?

If you miss the initial 12-month trial period and your Advantage company doesn’t give you another trial period, you will have to abide by very strict switching rules. 

First, if you want to switch to a different Advantage plan after the trial period ends, you can do so, but only between October 15th and December 7th. There is one other caveat. You will not be allowed to switch to a different Advantage plan if you have end-stage renal disease (permanent kidney failure). 

The second rule for switching after the trial period is for those of you who want to switch to a Supplemental plan. To do so, you will have to 1) enroll during the open enrollment period between October 15th and December 7th, and 2) go through medical underwriting and be approved by the Supplemental insurance company. Typically, the medical underwriter will ask you a series of 25 health questions, check to see what medications you’re taking, and explore your pre-existing health conditions. They may also require a statement from your doctor. If you have anything going on with your health, the insurance company can deny you coverage. This is why it’s important to take advantage of the 12-month trial period when you can switch to any plan you’d like, no medical underwriting required. 

Conclusion

The Advantage plan 12-month trial period gives you the opportunity to test the plan out and make sure it’s right for you. This trial period begins the day you turn 65 and enroll in Medicare. If you miss the initial 12-month trial period, your Advantage company may not give you another trial time. Once the trial period is over, it’s much harder to switch plans. In fact, if you have serious health issues, it may be impossible for you to switch to a new plan after the Advantage Plan 12-month trial period is over. 

We understand how difficult making the right Medicare decisions can be. To take the next step, watch our full course here, or schedule a free one-on-one call with a certified Medicare School Guide who can answer your questions, compare plans options, and even help you enroll. Click here to get started.

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