Leaving Medicare Advantage during your 12-month trial

A step-by-step consumer guide to protecting your right to a Medigap policy

A ConsumerNews.ai consumer resource — June 17, 2026

As The Outraged Consumer and others reported earlier, many of the largest Medicare Advantage insurers are denying prior authorization for long-term and rehabilitative care.

This is driving many seniors who opted for Medicare Advantage – which was sold to them as a cost-saving tool – trying to return to "Original Medicare," which doesn't require prior authorization.

The problem – as with virtually all federal programs – is that Medicare and its various offshoots are so complex that they virtually defy understanding by those of normal intelligence.

Here's an attempt (assembled with AI assistance from various resources public and private) to explain the steps required to dump Medicare Advantage and return to the original version.

Warning: The federal law that grants this right does not require insurers to bend over backward — it requires you, the consumer, to file the paperwork on time and with proof. It will require some homework and attention to detail.

The good news: You can leave a Medicare Advantage plan and go back to Original Medicare any time you want.

The not-so-good news: The harder part is making sure you can also buy a Medicare Supplement (Medigap) policy to plug the 20 percent coinsurance and the absent out-of-pocket cap that Original Medicare leaves on the table. Federal law gives you one true escape hatch for that: the 12-month trial right. This guide walks you through exactly how to use it, what to document at each step, and how to confirm your local underwriting rules — for free — before you drop a thing.

Step 1 — Confirm you actually qualify for the trial right

Federal guaranteed-issue protections for Medigap are narrow. Of the seven or so federal triggers, the trial right is the one that gives a current Medicare Advantage enrollee the most flexibility. Two distinct versions exist under 42 U.S.C. § 1395ss(s):

• Trial Right A (first-time at 65):You enrolled in a Medicare Advantage plan when you first became eligible for Medicare at 65. If you decide within 12 months that Medicare Advantage is not right for you, you can return to Original Medicare and buy any Medigap plan sold in your state without medical underwriting, per Medicare.gov.
• Trial Right B (dropped Medigap to try MA):You previously had Original Medicare with a Medigap policy, dropped the Medigap policy to try Medicare Advantage for the first time, and want to switch back within 12 months. You can re-enroll in the same Medigap policy you had before if the insurer still sells it. If it does not, you can buy Medigap Plans A, B, D, G, K or L from any insurer in your state, per the National Council on Aging.

You do not qualify if: This is not your first time on Medicare Advantage. The right is a one-time protection. A senior who enrolled in Medicare Advantage at 65, switched to Original Medicare at 67, then re-enrolled in Medicare Advantage at 68 does not get a new 12-month trial right on the second enrollment, the Medicare Rights Center has consistently advised.

Special note for Maine residents: Maine extends the trial right from 12 months to 36 months, per AARP. You have up to three years to switch back and pick any Medigap policy.

Documentation to gather now:

• Your Medicare card (red, white and blue).
• Your Medicare Advantage enrollment letter or member ID card — the effective date is what starts your 12-month clock.
• The month and year you first enrolled in Medicare Part B (this confirms whether you are inside your initial Medigap open-enrollment window or relying on the trial right).
• If applicable, a copy of the Medigap policy you previously dropped (insurer name, plan letter, policy number) — needed for Trial Right B.

Step 2 — Call your State Health Insurance Assistance Program before you do anything else

This is the single most important step in this guide. State Health Insurance Assistance Programs — known as SHIPs — are federally funded, free, unbiased counseling services available in every state. They do not sell insurance and have no commission incentive. A SHIP counselor will tell you exactly what your local Medigap underwriting rules are, which insurers are selling which plans, and what your switch will cost, before you sign anything.

How to reach one:

• National SHIP locator and phone:1-877-839-2675, or visit shiphelp.org.
• Email: info@shiphelp.org.
• Or ask Medicare directly at 1-800-MEDICARE for your state SHIP number.

Ask the SHIP counselor these specific questions:

1. "Am I still inside my 12-month trial right window? My Medicare Advantage start date was."
2. "In my state, which Medigap plans are insurers required to issue to me under the trial right?"
3. "Does my state have additional Medigap protections beyond federal law?"
4. "If I miss the trial right, when is the next time I could buy Medigap without medical underwriting?"
5. "Can you confirm the standalone Part D plans available in my zip code and the late-enrollment penalty if I delay enrolling?"

Get the counselor's name, the date of the call, and a written summary by email if possible. Keep this in your file.

Step 3 — Verify your state's underwriting rules in writing

Federal law sets a floor. States can go further. Where you live determines how much room you have if you miss the trial right — and whether the trial right itself is enhanced.

Year-round or annual guaranteed-issue states (no medical underwriting at any time for beneficiaries 65 and older):

• Connecticut— continuous guaranteed issue year-round, no underwriting at any time, per a KFF analysis.
• New York— continuous guaranteed issue year-round, no underwriting, per the New York Health Access detailed reference.
• Massachusetts— regulation requires an annual February 1 to March 31 open enrollment window, but in practice all carriers in the state offer continuous open enrollment.
• Maine— guaranteed-issue for Plan A only during one insurer-chosen month each year, plus the 36-month extended trial right described above.
• Minnesota— new annual guaranteed-issue window for ages 65 to 70, slated to take effect August 1, 2026; can only be used once and carries a premium loading of 15 to 35 percent, per KFF.

Birthday-rule states (annual switching window, usually for existing Medigap holders changing plans):

Sixteen states now have a birthday rule, per medicareresources.org and the Senior Market Sales 2026 reference: California, Delaware (Jan. 1, 2026), Idaho, Illinois, Indiana (Jan. 1, 2026), Kentucky, Louisiana, Maryland, Nevada, Oklahoma, Oregon, Utah, Virginia, West Virginia (June 1, 2026), Wyoming and New Mexico (Jan. 1, 2027). The windows generally run 30 to 63 days around a beneficiary's birthday and most are limited to plans with equal or lesser benefits. Important: birthday rules apply to people who already have a Medigap policy — they do not give a Medicare Advantage enrollee a separate path back to Medigap, per a Senior65 California guide.

All other states: Outside the trial right and the other narrow federal triggers (plan termination, geographic move, employer coverage loss, insurer bankruptcy or fraud), insurers can medically underwrite, deny coverage, or charge higher premiums based on health.

Document to request: Ask your state insurance department for its current Medigap consumer guide. Most are free PDFs. The guide will list every insurer licensed to sell Medigap in the state, the plan letters they offer, and current premium ranges. Save the date you downloaded it.

Step 4 — Get Medigap quotes BEFORE you disenroll from Medicare Advantage

Do not disenroll first and shop second. The sequence matters because the trial right protects you from underwriting only while the right is active. If you drop Medicare Advantage before lining up Medigap, and then the Medigap application gets delayed past your trial window, you can lose the protection.

Process:

1. Pull Medigap quotes from at least three insurers for your chosen plan letter — most consumer advocates recommend Plan G as the most comprehensive option for newer Medicare beneficiaries, since the popular Plan F is no longer available to anyone newly eligible for Medicare on or after Jan. 1, 2020, per Medicare.gov.
2. When you call, say clearly: "I am exercising my federal 12-month trial right under 42 U.S.C. 1395ss(s). I am requesting Medigap on a guaranteed-issue basis." Note the agent's name, the date and the quoted premium.
3. Ask each insurer in writing what proof of trial-right eligibility they require. Most will accept a copy of your Medicare Advantage member ID card showing the effective date, your Medicare card and a disenrollment confirmation letter.
4. Pick the insurer and lock in the premium quote in writing — typically the application packet itself constitutes the offer.

Step 5 — Apply for Medigap and ask for a same-day effective date

Federal anti-duplication rules under CMS Program Memorandum 02-01 generally bar an insurer from issuing a new Medigap policy before your Medicare Advantage coverage ends. The cleanest sequence is:

1. Submit your Medigap application now with a requested effective date that matches the first day of the month after your Medicare Advantage disenrollment takes effect.
2. Include a written promise to disenroll from Medicare Advantage as soon as the Medigap policy is in force. NAIC Model Regulation Section 18 requires this, and CMS confirms it in the program memorandum.
3. Get the insurer to confirm in writing that they have accepted the application on a guaranteed-issue basis with no underwriting. Save this confirmation — it is your evidence if anything goes wrong later.

Tip: CMS does not require insurers to process guaranteed-issue applications faster than other applications. Apply earlier in the month rather than at the deadline.

Step 6 — Disenroll from Medicare Advantage

You have three ways to disenroll:

1. Call 1-800-MEDICARE(1-800-633-4227, TTY 1-877-486-2048). Tell them you want to disenroll from your Medicare Advantage plan and return to Original Medicare. Note the representative's name, the date, the call reference number, and the effective date they give you.
2. Enroll in a standalone Part D planthrough Medicare.gov or by calling 1-800-MEDICARE. This automatically triggers disenrollment from your Medicare Advantage plan (you cannot have both at once). This is often the cleanest sequence because it ensures continuous drug coverage.
3. Send a written disenrollment requestto your Medicare Advantage plan. Use the plan's published disenrollment form — most insurers publish one on their member site. Send by certified mail with return receipt.

Form to know — but probably do not need: CMS Form 1763 is the federal "Request for Termination of Premium Part A, Part B, or Part B Immunosuppressive Drug Coverage." It is used to terminate Medicare itself — not to disenroll from a Medicare Advantage plan. Do not file CMS-1763 unless you genuinely want to end your Medicare coverage altogether.

When disenrollment takes effect:

• During the Medicare Advantage Open Enrollment Period (January 1 to March 31), the change takes effect the first day of the month after the plan receives your request.
• During the Annual Election Period (October 15 to December 7), the change takes effect January 1.
• Under a Special Enrollment Period — including the trial right — typically the first day of the month after the request.

Step 7 — Enroll in a standalone Medicare Part D plan

Original Medicare does not include prescription drug coverage. The trial right grants a Special Enrollment Period to join a Part D plan, per the National Council on Aging.

Critical timing: If you go more than 63 consecutive days without creditable prescription drug coverage after first becoming eligible, you can be hit with a permanent Part D late-enrollment penalty — roughly 1 percent of the national base premium for every month you went without coverage, added to your premium for life. Enroll in a Part D plan with a start date that begins the day your Medicare Advantage drug coverage ends.

Step 8 — Document everything and confirm in writing

Before you consider the switch complete, you should have all of the following on file. Keep paper or PDF copies for at least seven years.

• Original Medicare confirmation: A letter from Medicare or a screenshot from MyMedicare.gov confirming you are enrolled in Parts A and B and not in any Medicare Advantage plan, with an effective date.
• Medicare Advantage disenrollment confirmation: A letter from your former Medicare Advantage plan acknowledging disenrollment, with the last day of coverage.
• Medigap approval letter: Written confirmation from your Medigap insurer that the policy was issued on a guaranteed-issue basis under the federal trial right, with the effective date and premium.
• Part D enrollment confirmation: A letter from your standalone Part D plan with the effective date.
• Call log: A simple table — date, who you spoke with, what was said, reference number.
• Coverage gap proof: Verify the dates line up. There should beno gapbetween the last day of Medicare Advantage and the first day of Original Medicare + Medigap + Part D coverage.

Common pitfalls — and how to avoid each one

• "I disenrolled but didn't apply for Medigap, so I lost the trial right." Dropping Medicare Advantage without enrolling in Medigap does not preserve the right — you must do both before the 12-month window closes. Submit the Medigap application first.
• "I assumed I'd get guaranteed issue, but my state doesn't help me." Only the four KFF-confirmed states (Connecticut, Massachusetts, Maine, New York) offer year-round or annual guaranteed issue without underwriting at any time. Everywhere else, the trial right is your only sure path. Verify with your SHIP before disenrolling.
• "The insurer asked health questions on my application." During a federal guaranteed-issue event, insurers can ask health questions for administrative purposes but cannot deny coverage or rate based on health. If you are told otherwise, contact your state insurance department immediately and reference 42 U.S.C. 1395ss(s)(2)(A).
• "I waited until month 13 to apply for Medigap." Once the 12 months elapse, the trial right is gone. The window is firm; mark a calendar reminder for month 10.
• "I have a pre-existing condition waiting period." Federal law prohibits pre-existing condition exclusions for policies issued under guaranteed-issue rights. If you had less than six months of prior creditable coverage, ask the insurer to credit your Medicare Advantage time toward any waiting period.
• "I filed CMS-1763 by mistake." That form terminates your Medicare. Call Social Security at 1-800-772-1213 immediately if you sent one when you only intended to leave Medicare Advantage.
• "My Medigap policy started after my MA ended, leaving a gap." Always confirm both effective dates in writing before you confirm the switch. A one-day gap can disqualify you from preexisting-condition crediting and may expose you to a Part D late-enrollment penalty.

Useful contacts and forms

• 1-800-MEDICARE(1-800-633-4227): general Medicare help, disenrollment, plan comparisons.
• SHIP National Helpline: 1-877-839-2675; locator at shiphelp.org.
• Medicare Rights Center: 1-800-333-4114 — independent national helpline.
• Social Security: 1-800-772-1213 — only for Medicare enrollment or termination questions, not plan changes.
• Your state insurance department: enforces state-specific Medigap rules and pursues complaints.
• Medicare.gov plan finder: medicare.gov/plan-compare — official source for plan availability and pricing.
• CMS Form 1763(do not use to leave Medicare Advantage): cms.gov/medicare/cms-forms/cms-forms/downloads/cms1763.pdf.

Bottom line for seniors

The 12-month trial right is the single most important consumer protection a senior has when leaving Medicare Advantage. It is also the most easily forfeited.

The four steps that protect it are: confirm eligibility, call your free SHIP counselor before doing anything else, line up a Medigap policy before disenrolling, and document every effective date in writing.

As noted earlier, the federal law that grants this right does not require insurers to bend over backward — it requires you, the consumer, to file the paperwork on time and with proof. Do that, and you can leave Medicare Advantage with the same insurance protections you would have had if you had chosen Original Medicare from the start. Miss the window, and outside of the four protective states, you may not be able to buy a Medigap policy at any price.