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Medicare if You’re in Prison: What to Know

A male prisoner on a phone with his female visitor also on a phone as they touch the glass between them with their hands.

If you or a loved one is in prison, you may be concerned about your access to healthcare and how being incarcerated impacts your Medicare coverage.

Here’s what to know…

Medicare Coverage During Incarceration

Medicare coverage is available to eligible individuals including those aged 65 or older, certain disabled individuals and individuals with End-Stage Renal Disease (ESRD). However, if you become incarcerated, your Medicare coverage may be affected depending on the type of Medicare plan you have. If you’re incarcerated some special rules apply to your health care options.

a. Original Medicare (Part A and Part B):

If you have Original Medicare, your coverage will generally continue during your time in prison. Part A (hospital insurance) and Part B (medical insurance) benefits will remain intact. It’s essential to ensure that your premium payments are up-to-date, even while incarcerated, to maintain continuous coverage.

b. Medicare Advantage (Part C):

Medicare Advantage plans, offered by private insurance companies approved by Medicare, may have varying policies regarding coverage during incarceration. Some plans may suspend coverage while others may continue providing benefits. It’s important to contact your Medicare Advantage plan provider directly to inquire about the specifics of your coverage during imprisonment.

Reinstating Medicare Coverage After Release from Prison

Upon release from prison, it’s essential to promptly reinstate your Medicare coverage to ensure that you have continued access to healthcare services. Failing to do this might lead to penalties or delays in coverage. The process for reinstatement will depend on your specific situation and the type of Medicare plan you have.

a. Original Medicare (Part A and Part B):

If you had Original Medicare coverage before incarceration, it will automatically resume after your release. Reach out to the Social Security Administration (SSA) to update any necessary information and ensure a seamless continuation of your benefits.

b. Medicare Advantage (Part C) and Prescription Drug Coverage (Part D):

For those with Medicare Advantage plans or Part D, contact your plan provider immediately upon release to discuss reinstating your coverage. They will guide you through the necessary steps and help you navigate the process smoothly. But, in general, when you are released, you have a Special Enrollment Period (SEP) to join a Part D plan or a Medicare Advantage Plan. Your SEP begins as early as the month before your release and lasts up to two months after you are released. For example, if you are scheduled for release April 1, your SEP is March 1 through May 31. You must inform the plan you choose of your address so they can confirm you are in their coverage area and eligible to enroll in that plan.

Want more? You may be interested in reading our blog, Budgeting for Medicare Costs: 6 Tips to Help

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Colonial Penn is a private company that is not Medicare, Medicaid or MaineCare and is not a governmental agency

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