A California beneficiary joins a Medicare Advantage plan for the first time and then disenrolls within the trial period because the plan does not meet their needs. What Medigap protection applies under California law?
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
CIC Section 10192.12 grants Medigap guaranteed issue rights in specified circumstances — for example, when a person loses coverage through no fault of their own, or when a beneficiary enrolled in a Medicare Advantage plan for the first time disenrolls within the trial period (the first year of MA enrollment). In those situations, a Medigap insurer must accept the application and cannot apply medical underwriting or impose pre-existing condition waiting periods. This trial right encourages beneficiaries to try Medicare Advantage without giving up the safety net of Medigap. It is a California-specific protection tested under AH-III.D.1e.
Why the other options are wrong
- B) Guaranteed issue rights apply at the moment of the qualifying event, such as MA trial-period disenrollment; waiting for an open enrollment window is not required.
- C) No rule limits trial-period disenrollees to high-deductible plans; guaranteed issue applies across the standardized plan options.
- D) The trial right exists precisely so MA enrollment does not destroy Medigap access; the beneficiary does not lose the right to buy Medigap.
Memory hook
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