The Centers for
Medicare and Medicaid Services (CMS) provides a Special Enrollment
Period (SEP) for people who left their Medicare Supplement (Medigap
plan) -- joined a Medicare Advantage plan for the first time -- and within the first 12 months these people wish to leave the new Medicare Advantage plan and return to their original Medicare Supplement.
Medicare beneficiaries will use the SEP to leave their Medicare Advantage plan and return to their Medicare Supplement (or an equivalent Medigap plan if the original Med Supp is no longer available).
A similar "trial right" Special Enrollment Period is also available for people who enrolled into a Medicare Advantage when they were first eligible for Medicare and during the first 12 months, they wish to leave the Medicare Advantage plan, return to Original Medicare and join a Medicare Supplement.
Where can we find this Special Enrollment Period?
The Special Enrollment Period is defined in Chapter 2 of the Medicare Managed Care Manual
"Medicare Advantage Enrollment and Disenrollment":
beneficiaries who dropped a Medigap policy when they enrolled for the
first time in an MA plan, §1882(s)(3)(B)(v) of the Act provides a
guaranteed right to purchase another Medigap policy if they disenroll
from the MA plan while they are still in a 'trial period.' In most
cases, a trial period lasts for 12 months after a person enrolls in an
MA plan for the first time. Such individuals would not be eligible for
the special election period [SEP] provided for in the last sentence of
§1851(e)* of the Act, because they did not enroll in an MA plan
immediately upon becoming Medicare eligible, but instead had been in the
Original Medicare Plan for some period of time. The right to 'guaranteed issue' of a Medigap policy under §1882(s)(3)(B)(v) of the
Act would be meaningless if individuals covered by this provision could
not disenroll from the MA plan while they were still in a trial period."
there is an SEP for individuals who are eligible for “guaranteed issue”
of a Medigap policy under §1882(s)(3)(B)(v) of the Act upon
disenrollment from the MA plan in which they are enrolled. This SEP
allows a qualified individual to make a one-time election to disenroll
from their first MA plan to join the Original Medicare Plan at any time
of the year. The SEP begins upon enrollment in the MA plan and ends
after 12 months of enrollment or when the beneficiary disenrolls,
whichever is earlier. The effective date would be dependent upon the
(Medicare Managed Care Manual, Chapter 2 - Medicare
Advantage Enrollment and Disenrollment, Section 30.4.4- SEPs for
Exceptional Conditions, 6. SEP for Individuals Who Dropped a Medigap
Policy When They Enrolled
For the First Time in an MA Plan, and Who Are Still in a “Trial Period”,
42 CFR 422.62(b)(4) (Rev. 1, Issued: July 31, 2018;
Effective/Implementation: 01-01-2019) (Updated: August 19, 2011
(Revised: November 16, 2011, August 7, 2012, August 30, 2013, August 14,
2014, July 6, 2015, September 1, 2015, September 14, 2015, December 30,
2015, May 27, 2016, August 25, 2016, June 15, 2017 & July 31,
*The last sentence in Section 1851(e)(4) of the Social Security Act, "Special Election Periods" notes:
"Effective as of January 1, 2006, an individual who, upon first becoming eligible for benefits under part A at age 65, enrolls in a Medicare+Choice [Medicare Advantage] plan under this part, the individual may discontinue the election of such plan, and elect coverage under the original fee-for-service plan, at any time during the 12–month period beginning on the effective date of such enrollment."
More about the two "trial rights" allowing a person to leave a
Medicare Advantage plan and join (or return to) a Medicare Supplement
CMS provides two Medicare Advantage plan "trial periods" allowing a
to return to a Medicare Supplement policy with guaranteed issue rights (no medical underwriting) - and, depending on where you live, your state may provide additional guaranteed issue rights for joining a
Medicare Supplement (for example, California, Connecticut, Massachusetts, Maine, and New York may provide Medicare beneficiaries additional rights).
Trial Right #1
- You join a Medicare Advantage plan when you are first eligible for Medicare and within the first 12 months, you wish to leave the Medicare Advantage plan, return to Original Medicare and join a Medicare Supplement.
If you joined a Medicare Advantage plan (MA or MAPD
) when you were first eligible for Medicare (you turned 65) and within 12 months
of joining the Medicare Advantage plan (your trial period), you decide
to leave the Medicare Advantage plan, you are provided a guaranteed
issue right to join any Medicare Supplement that is available in your
As noted by the Centers for Medicare and Medicaid Services (CMS):
y]ou joined a Medicare Advantage Plan (like an HMO or PPO) or Programs
of All-inclusive Care for the Elderly (PACE) when you were first
eligible for Medicare Part A at 65, and within the first year of
joining, you decide you want to switch to Original Medicare - You have
the right to buy [a]ny Medigap policy that's sold in your state by any
If you are outside of this 12 month "trial period", you may be subject
to medical underwriting (again, some states provide for more generous
"guaranteed issue" rights).
Trial Right #2
- You left your Medicare Supplement and joined a
Medicare Advantage plan and within 12 months decide to leave your
Medicare Advantage plan and return to your Medigap plan.
If you were enrolled in a Medicare Supplement and leave your
Medicare Supplement to join a Medicare Advantage plan, you will be
granted a Special Enrollment Period to return to your Medigap plan (or
other plan if no longer available) within the first 12 months of
Medicare Advantage plan enrollment.
CMS allows the "trial period" if:
dropped a Medigap [or Medicare Supplement] policy to join a Medicare
Advantage Plan (or to switch to a Medicare SELECT policy) for the first
time, you’ve been in the plan less than a year, and you want to switch
back - you have the right to buy [t]he Medigap policy you had before you
joined the Medicare Advantage Plan or Medicare SELECT policy, if the
same insurance company you had before still sells it."
If your former Medigap policy isn’t available, you can buy Medigap Plan A, B, C*, D*, F*, G*, K, or L that’s sold in your state by any insurance company.
If your former Medicare Supplement is no longer in existence, you will
be permitted to join Medicare Supplement Plan A, B, C, F, K, or L "that’s sold in your state by any insurance company".
(Remember that Medigap Plan C and Plan F
will no longer be accepting enrollments
starting in 2020.)
(Source: Choosing a Medigap Policy: A Guide to Health Insurance for
People with Medicare, Centers for Medicare and Medicaid Services, https://www.medicare.gov/Pubs/pdf/02110-medicare-medigap-guide.pdf)