If you turn 65 and qualify for Medicare while incarcerated, you will qualify for a Part B Special Enrollment Period (SEP) Special Enrollment Periods (SEPs) are periods of time outside normal enrollment periods when you can enroll in Medicare or change your health and/or drug coverage. One example is the Part B SEP, which allows you to enroll in Part B without penalty while you have job-based insurance and for eight months after you lose the insurance or stop working. SEPs triggered by specific circumstances may also allow you to switch or disenroll from Part D and Medicare Advantage Plans. For example, if you moved out of your plan’s service area, you would receive an SEP to switch to another plan. to enroll in Medicare without penalty when you are released. In order to use this SEP, you must have been released from incarceration on or after January 1, 2023.
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Contact your local State Health Insurance Assistance Program
Each state offers a SHIP, partly funded by the federal government, to give you free counseling and assistance. A SHIP counselor may be available by phone or in person.
Visit www.shiptacenter.org to find your local SHIP office.
Contact your local State Health Insurance Assistance Program
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[glossary_exclude]Each state offers a State Health Insurance Assistance Program (SHIP), partly funded by the federal government, to give you free counseling and assistance. A SHIP counselor may be available by phone or in person.[/glossary_exclude]
Visit www.shiptacenter.org to find your local SHIP office.
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When to use Special Enrollment Period
Your SEP lasts for 12 months. It begins the day you are released from incarceration, and it ends the last day of the twelfth month after you are released. Being released from incarceration means that you are no longer in the custody of a penal authority. Examples of being in custody can include people who are in prison, people under house arrest, and people under supervised release.
You have two choices for when Medicare coverage can begin:
- You can choose to have coverage begin on the first of the month after the month you enroll
- You can choose to have coverage begin up to six months retroactively (but it cannot begin before January 1, 2023 or before you were released from incarceration)
If you do not enroll into Medicare within 12 months of being released, you may have to wait until the General Enrollment Period (GEP) to enroll. The GEP is January 1 through March 31 of each year, with coverage starting the first of the month after the month of enrollment. If you enroll during the GEP, you may have a Part B late enrollment penalty A late enrollment penalty is an amount you must pay to Medicare in addition to the regular monthly premium for late enrollment in Part B or Part D. The Part B premium penalty is 10% of the Part B premium for each 12-month period you delayed enrollment without insurance from your or your spouse’s current work. The Part D premium penalty is 1% of the Part D premium for each month you delayed enrollment without creditable drug coverage. . The penalty makes your Medicare coverage more expensive.
If you are under 65, qualify for , and are within your two-year waiting period for Medicare before incarceration, the time you spend incarcerated will not count toward your two-year waiting period. Once your SSDI benefits are reinstated after your release, time spent toward your two-year waiting period will resume.
Options if you do not qualify for Special Enrollment Period
If you were released from incarceration before January 1, 2023 and you need to enroll in Medicare, you will likely have to use the GEP. If you qualify for a Medicare Savings Program (MSP), you can be enrolled in Medicare Part B outside of the GEP and you will not have a late enrollment penalty. Contact your State Health Insurance Assistance Program (SHIP) to learn if you qualify for an MSP.