Medicare coverage during incarceration

Incarceration can affect your Medicare Medicare Medicare is the federal government health insurance program that provides health care coverage if you are 65 or older, are under 65 and receive Social Security Disability Insurance (SSDI) for 24 months, begin receiving SSDI due to ALS/Lou Gehrig’s Disease, or have End-Stage Renal Disease (ESRD) no matter your age. You can receive health coverage directly through the federal government (see Original Medicare) or through a private company (see Medicare Advantage).  coverage (you are incarcerated if you are in prison, jail, or otherwise in the custody of penal authorities). If you had Medicare before your arrest, you will remain eligible for the program while you are incarcerated. However, Medicare generally will not pay for your medical care. Instead your correctional facility will provide and pay for your care. Once you are released, Medicare will resume coverage if you remained enrolled.

Once you are incarcerated for 30 days or more and are convicted of a crime, any Social Security retirement benefits or Social Security Disability Insurance (SSDI) Social Security Disability Insurance (SSDI) Social Security Disability Insurance (SSDI) is a monthly benefit provided through the Social Security Administration for people who are unable to work because of a severe medical impairment (disability). People who receive SSDI for 24 months are eligible for Medicare. you receive will stop. Your benefits can be reinstated after your release. Note that if you are under 65 and qualify for Medicare due to disability, you must reinstate your SSDI in order to resume Medicare coverage. To learn about the requirements for reinstating your benefits, contact the Social Security Administration (SSA) Social Security Administration (SSA) The Social Security Administration is the United States government agency responsible for managing various programs, including Medicare, Social Security Disability Insurance (SSDI), Supplemental Security Income (SSI), and Extra Help. .

It is usually best to keep Medicare Part A and Part B coverage while you are incarcerated. Although Medicare will not cover your care, keeping it will ensure that you avoid late enrollment penalties and gaps in coverage when you are released. Most people pay no premium for Part A Part A Part A, also known as hospital insurance, is the part of Medicare that covers most medically necessary hospital inpatient care, skilled nursing facility (SNF) care, home health care, and hospice care. but do pay a monthly premium for Part B Part B Part B, also known as medical insurance, is the part of Medicare that covers most medically necessary doctors’ services, preventive care, hospital outpatient care, durable medical equipment (DME), laboratory tests, x-rays, mental health services, and some home health care and ambulance services. . (See below for information about benefits that can help pay your Part B premium.) To keep Part B benefits while incarcerated, you will need to keep paying your Part B premiums. For those who are not incarcerated, these premiums are deducted from Social Security benefits each month. Since incarcerated individuals have their Social Security benefits suspended, you would need to pay the Part B premium by setting up direct payment with Medicare. You can do this by calling 1-800-MEDICARE within 30 days of your conviction.

If you cannot afford to continue paying the Part B premium during your incarceration:

1. You should actively withdraw from Part B instead of being disenrolled to avoid owing premiums to SSA. If you do nothing, SSA will continue to bill you for Part B and disenroll you after you fail to pay your premiums. When you re-enroll in Part B upon release, SSA will deduct any unpaid premiums from your Social Security benefits.
2. See whether you qualify for a Medicare Savings Program (MSP). MSPs pay your Part B premiums, help you enroll in Medicare outside typical enrollment periods enrollment periods Enrollment periods are certain periods of time when you can join the Original Medicare program, or enroll in a Medicare Advantage Plan, Part D plan, or supplemental insurance plan (Medigap). See also: Fall Open Enrollment, Medicare Advantage Open Enrollment Period, General Enrollment Period, Initial Coverage Election Period, Initial Enrollment Period, Medigap Open Enrollment Period, and Special Enrollment Period. , and waive premium penalties. In some states, you may be able to apply for an MSP while you are incarcerated. If you do qualify for an MSP, aim to enroll into the MSP in the two months before your release. Typically, you should receive a decision within 45 days of filing an application. If your state does not allow you to apply for an MSP while you are incarcerated, apply as soon as you are released. Be sure to apply for an MSP in the state you will reside in after release. If you had an MSP before your incarceration, it will typically stop once you are taken into custody. You will likely need to re-apply for benefits to start upon your release.

For more information regarding eligibility and application requirements for an MSP in your state, contact your local Medicaid office or your State Health Insurance Assistance Program (SHIP).