Incarceration and Health Insurance
Do Incarcerated Individuals Get Healthcare?
Incarcerated Individuals and Marketplace Health Coverage, Private Health Coverage, Medicaid, Medicare, and SSI
We explore the rights of incarcerated individuals to Medicaid, Medicare, and SSI, which provide continued care for incarcerated people after confinement. All incarcerated people have a right to medical care and attention. However, incarcerated individuals don’t have the same health plan options (and rules can differ somewhat state-to-state).[1]
What does it mean to be incarcerated? An incarcerated person is one serving prison or jail time after having been convicted of an offense. This category does not include those in residential facilities or homes under the criminal justice system’s supervision, nor does it include those who are confined while waiting for a trial.
Incarceration and Marketplace Coverage
If you’re incarcerated, you can’t use the Health Insurance Marketplace to buy a private insurance plan, buy a private plan outside of the marketplace, or receive Medicaid or Medicare benefits. However, after you’re released, you can. With that said, if you are in prison or jail and pending disposition of charges or waiting for a trial (if you are being held but have not been convicted), you may create a Marketplace account if you are eligible for Marketplace coverage (or enroll in another type of coverage).
Enrolling in a Health Plan after being released from incarceration: After you’re released, you have a 60-day Special Enrollment Period to sign up for private health coverage. During this time, you can enroll in private health insurance even if it’s outside the Marketplace Open Enrollment Period. You may be eligible for subsidies depending on your income and state of residence, but remember that you can only obtain this assistance by choosing a marketplace plan (so starting with the official marketplace HealthCare.Gov is a good first step).
Incarceration and Medicaid
You can use the Marketplace to apply for Medicaid, apply with a paper application, or get help in applying at a Medicaid office. Medicaid will not pay for your care while you are incarcerated, but it may enable you to get care as soon as you are released.
Medicaid eligibility is based on income, and rules differ by state, but there is no specific window in which you must apply for coverage. People can enroll in Medicaid 365 days a year if they qualify. Still, it makes sense to apply as soon as you can.
There is information on State Medicaid Eligibility Policies for Individuals Moving into and Out of Incarceration on the Kaiser Family Foundation site. See a list of State Medicaid offices.[2]
Incarceration and Medicare and SSDI
If you have Medicare coverage and you are incarcerated, your benefits under both Medicare and SSDI will automatically stop once you are in jail for 30 days or are convicted of a crime. For helpful information, see The Medicare Interactive site, Introduction to Medicare and Incarceration[3]
Once you know your release date, you will need to contact Social Security to find out how to reinstate your Medicare or SSDI benefits.
Benefits are usually reinstated the month following the month of your release. If you receive SSI and are incarcerated for over 12 months, you will have to re-file for benefits when you are released.
You still have to pay Medicare premiums when incarcerated: If you are incarcerated, you need to set up a direct payment of your Part B premium. You can do this by phoning Medicare. There are real issues one can run into with missed Part B payments, so it is vital to do this. If you don’t arrange for Part B to be paid automatically, your payments will stop, and Part B will lapse; it could take months to get Part B back after you are released, and you may face lifelong penalties. If you can’t afford to keep Part B, you should notify Medicare and withdraw. If you do nothing, you will have unpaid premiums that you will owe once you are released. You might qualify for a Medicare Savings Program. MSPs can pay some of your Medicare costs. There are some income and asset guidelines. Both the guidelines and enrollment periods will vary from state to state, so you need to apply and see what you qualify for. Some states allow you to apply while incarcerated; others do not.
TIP: In many instances, Medicaid, Medicare, and SSDI will simply be put on pause during a period of incarceration so you won’t have to reapply when you get out. You will have to take some action to start up your Medicaid, SSI, or Medicare. The exact process you need to go through can be different in every state, especially with Medicaid, so make sure to find out the specific rules for your state.[4]
Coverage for an Incarcerated Person’s Dependents
If an incarcerated person’s spouse or children receive monthly SSI benefits through them, they will continue to be eligible for those benefits while the person is incarcerated.
For more information, contact socialsecurity.gov or phone 800-772-1213 or the TTY line 800-325-0778.
- Incarcerated people Health coverage for incarcerated people
- State Medicaid Eligibility Policies for Individuals Moving into and Out of Incarceration
- Introduction to Medicare and Incarceration
- Incarceration overview – Washington State as an example of a state that allows you to “put Medicaid on pause” while incarcerated.
