What are the rules & guarantees about if you get a
Medicare Advantage Plan MAPD and
then you would rather switch to Originial Medicare A-Hospital & B- Doctor Visits and a Medi-Gap plan?

There is a 12 month trial period in which you can test drive an MAPD.  This trial period can be  either when you first turn 65, or you drop a Medi-Gap plan to enroll in a MAPD Plan.

Trial Rights MAPD back to Medi GapPublication 02110 Page 23 Choosing a Medi-Gap Policy

Blue Shield Guaranteed Trial Right

Blue Shield Guaranteed Issue Rights

CA Health Care Advocates *  Medicare & You – See link in Side Panel

 

FAQ’s

What if you are past the 12 month period – but less than 2 years?

Email us and we can send you the information for the unnamed company below.

I don’t like the unnamed company or just want to know how I can get a Medi-Gap plan.

There might be other guaranteed reasons for you.  See our webpage on that.

I don’t have a guaranteed reason, what kind of underwriting is there?

Check the health questions on the paper applications for the Companies we represent.

Trial Period and the 24 Month Rule

This rule is from an unnamed company that doesn’t allow agents to post any meaningful information on their websites.  This company is more liberal than required.  The law says one year. Scenario 1 – in this situation, an individual currently has a Medicare Supplement and goes to a Medicare Advantage January 1st, 2015 for the very 1st time.

  1. From February 1st, 2015 through December 31st of 2015, the individual will be in a Trial Period and can exit their existing MAPD Plan – they can enroll in an … at any time during the Trial Period – for example, if it is June of 2015 and the member wants to switch to a …with a July 1st effective date, they can do so – also, they can enroll in a PDP for a July 1st effective date.
  2. If the individual choose not to exit their MAPD Plan during the initial Trial Period – January 1st, 2015 through December of 2015, they will no longer have a Trial Period Guarantee Issue option with us – however, they will have an additional guarantee issue opportunity with us if the following holds true – they maintain the same MAPD Plan relationship they had in 2015 – meaning, if they had an MAPD Plan with company ABC, they must continue to have an MAPD Plan with company ABC in 2016 – if they do, they will have three possible windows for a guarantee issue – 1st, the Annual Disenrollment Period (January through February 14th) – 2nd, any available Special Election Period – 3rd, the 2016 Annual Election Period.

Scenario 2 – in this situation, an individual enrolls in an MAPD Plan for the very 1st time and they following must take place – first, it must be the first time in an MAPD Plan – second, they must enroll in the MAPD the month their Part A is effective and it must also be the same month the member turns 65 – third, the MAPD Plan must have the same effective date – so, if the member turns 65 in July of 2015, their Part A must be effective in July of 2015 and the MAPD must be effective July of 2015 – if that is the case the following applies:

  1. The individual will be in a Trial Period from July of 2015 through June of 2016 and can exit their existing MAPD Plan – they can enroll in an … Medicare Supplement at any time during the Trial Period – for example, if it is April of 2016 and the member wants to switch to a … Medicare Supplement with a May 1st effective date, they can do so – also, they can enroll in a PDP for a May 1st effective date.
  2. If the individual choose not to exit their MAPD Plan during the initial Trial Period – July 1st, 2015 through June of 201, they will no longer have a Trial Period Guarantee Issue option with us – however, they will have an additional guarantee issue opportunity with us if the following holds true – they maintain the same MAPD Plan relationship they had in 2015 – meaning, if they had an MAPD Plan with company ABC, they must continue to have an MAPD Plan with company ABC in 2016 – if they do, they will have three possible windows for a guarantee issue – 1st, the Annual Disenrollment Period (January through February 14th) – 2nd, any available Special Election Period – 3rd, the 2016 Annual Election Period.

Exercise:

  1. Individual is 70 years old, had a Medicare Supplement for 5 Years – switched to an MAPD January 1st, 2014 – has maintained the same MAPD relationship – are they in there Trial Period – Answer – yes
  2. Individual is 66 years old – had Medicare Part A and Part B for 6 months – goes to a Medicare Supplement for 6 months and changes to an MAPD for the 1st time January 1st, 2014 – maintains the same MAPD relationship – are they in the Trial Period – Answer – yes
  3. Individual is 75 years old – had an MAPD plan – went to a Medicare Supplement and went back to an MAPD Plan in 2014 – do they have a Trial Period – Answer – no (second time in an MAPD)
  4. Individual is 70 years old, had a Medicare Supplement for 5 Years – switched to an MAPD for the 1st time January 1st, 2014 – they choose to stay with the same MAPD carrier for 2015 – will they have a guarantee issue opportunity – answer – yes – we extend the guarantee issue window an additional 12 months if the member exits during the Annual Disenrollment Period, or exits due to a Special Election Period or exits due to the Annual Disenrollment Period for 2016.

These rules are very complex.  Do NOT rely on what you read on the Internet, even our website.  Double check!!!  Email us and include all the details and actual documents or screen shots.

The Medicare Advantage Open Enrollment Period ( MA OEP) 

  • During the MA OEP, Open Enrollment MA plan enrollees customers may:
    • enroll in another MA PD plan or disenroll from their MA plan and return to Original Medicare.
      • Individuals may make only one election during the MA OEP.:
  • Who can use the MA OEP: MA OEP occurs:
    Individuals enrolled in MA plans as of January 1 January 1 – March 31
    New Medicare beneficiaries who are enrolled in an MA plan during their ICEP (Initial Coverage Election Period) The month of entitlement to Part A and Part B – the last day of the 3rd month of entitlement
  • Individuals may add or drop Part D coverage during the MA OEP. Individuals enrolled in either MAPD or MA-only plans can switch to:
    • MA-PD (Medicare Advantage)
      • MA-only
      Original Medicare (with or without a stand-alone Part D plan) 
      The effective date for an MA OEP election is the first of the month following receipt of the enrollment request.
  • NOTE:
  • The MA OEP does not provide an opportunity for an individual enrolled in Original Medicare to join a MA PD plan. It also does not allow for Part D changes for individuals enrolled in Original Medicare, including those enrolled in stand-alone Part D plans.  Medicare Managed Care Manual Chapter 2 *   Section 30 - Election Periods   CA Health Advocates.org  * 42 CFR §§ 422.62 & 422.68  *  Medicare & You - See link in Side Panel * 

You have the opportunity to make one change to your  health coverage during the annual Medicare Advantage Open Enrollment Period.

FAQ's 

What type of plan can you switch to during the annual Medicare Advantage Open Enrollment Period?

During this time, you can:

Switch to another Medicare Advantage plan. (You choose a plan that covers prescription drugs or one that does not cover prescription drugs.)

Disenroll from an MAPD plan and obtain coverage through Original Medicare

You can apply for Medi Gap, but it may not be guaranteed issue and require underwriting.  If that's your plan, get approved for Medi Gap FIRST!!! 

If you choose to switch to Original Medicare during this period, you have until March 31 to join a separate Medicare prescription drug plan to add drug coverage.   We are not interested in writing people though who wait till the last minute.  If that's your plan please find another agent or go direct to Medicare.Gov  Things get lost... 

When will your membership end?

Your membership will end on the first day of the month after you enroll in a different Medicare Advantage plan or we get your request to switch to Original Medicare. If you also choose to enroll in a Medicare prescription drug plan, your membership in the drug plan will begin the first day of the month after the drug plan gets your enrollment request.    Evidence of Coverage  §2.2 page 240Page 52 Medicare Manual42 CFR 422.62(a)(3)  *   insuremekevin.com/new-medicare-advantage-open-enrollment-period-for-2019

New MAPD Open Enrollment Period  1.1 to 3.31

CA Health Advocates.org

Medicare & You - See link in Side Panel

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Medicare and You 2020 #10050  
Everything you want to know 

Medicare and you

Different Parts of Medicare 

A = Hospital
B = Doctor Visits - Out Patient
C = Medicare Advantage or Medi Gap
D = Part D Rx

Video

Understanding your Medicare Choices
Medi Gap vs Medicare Advantage

Topics

How to sign up for Parts A & B
Is  your test, service, or item covered?
Original Medicare Parts A & B
Medicare Advantage Plans & Part D Rx
Supplement Insurance (Medigap)
Low Income Help  LIS
Definitions


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Guaranteed Acceptance Guide
Rev 9.2019
Blue Shield CALIFORNIA 

This is just a summary of the major reasons.  Check this entire page and website for all situations and Insurance Carriers.

Enrolled in Medicare and are age 65 or older; or  New to Medicare, are age 64 or younger, and do not have end-stage renal disease

You enrolled with  A Medicare Advantage Plan and the plan is being terminated;

terminated from any employer-sponsored health plan,

moved outside the plan’s service area.

disenrolled from the plan or program within twelve (12) months of the effective date of that enrollment.

You terminated enrollment in a Medicare Supplement plan and subsequently enrolled, for the first time, in any of the following:
• A Medicare Advantage Plan;

MAPD Trial Privileges #02110 Medi-Gap Guide

The company substantially violated a material provision of the contract; or

The company or its agent materially misrepresented a provision of the plan in marketing the contract to you.

You enrolled in a Blue Shield Medicare Advantage Plan, and Blue Shield either:
Reduced any of its benefits;
Increased the amount of cost-sharing or premium; 

You are no longer eligible for Medi-Cal benefits.

References:

CA Health Care Advocates
Federal Choosing a Medi Gap Policy  #02110
Guaranteed Acceptance Guide Blue Shield

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7 comments on “MAPD Trial Period – Come back to Medicare and Medi-Gap

  1. I enrolled in a Medi-Gap plan, last year when I turned 65.

    If I enroll in a Medicare Advantage plan, can we go back to our Medi Gap plan anytime in 2020 or do we have to wait for Open Enrollment, 10.15 to 12.7 annually?

    • Thank you for your question. It’s helps us build our website and make sure it’s understandable to our visitors. We’ve reorganized this page to make it more clear. If you cancel the MAPD plan within 12 months, you can go back to your Medi Gap plan.

      If you stay in the MAPD plan longer than a year, you would have to meet underwriting – health questions to get a Medi Gap policy. There might be some Insurance Companies more liberal, but the law doesn’t require it.

    • The Open Enrollment Period is only for MAPD and Part D Rx guaranteed sign up, switching plans or going back to original medicare, Parts A & B.

      After the 1st year, that’s when you can get out of a MAPD plan.

      Again, if you are in a MAPD plan longer than a year, it’s not guaranteed issue to get your Medi Gap plan back

  2. If I understand it, this benefit – Right to get a Medi Gap Plan occurs because there is a “trial” period for MA in certain cases.

    However, those cases don’t seem to include the case in which MA was obtained upon returning from overseas.

    What am I missing?

    • Yes. That’s what this whole page is about. See above for details and explanation. If you have further questions, just use the “reply” button.

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