Medicare and Incarceration: What You Need to Know

If you’re preparing for incarceration, understanding how Medicare works during this time is crucial to avoid losing coverage or facing unexpected costs. Here’s an overview of what happens to your Medicare benefits before, during, and after incarceration.

What Does “Incarceration” Mean for Medicare?

Medicare considers you incarcerated (or “in custody of penal authorities”) if you are:

• Confined in a jail, prison, penitentiary, or similar institution.
• On medical furlough or a similar arrangement.
• Required by criminal law to live in a mental health facility.
• Or have escaped from confinement.

What Happens to Medicare During Incarceration?

Medicare Part A (Hospital Insurance)

• If you already have Medicare, your Part A entitlement continues while you’re in custody.
• However, Medicare does not pay for medical care provided by or through the correctional facility, since the institution is responsible for your healthcare.
• If you have premium-free Part A (most people do), you won’t lose it during incarceration.
• If you pay a premium for Part A, you must continue paying it to keep coverage.

Medicare Part B (Medical Insurance)

• You can keep Part B during incarceration, but you must continue paying your monthly premium directly.
• Because Social Security benefits are suspended for most people during incarceration, you’ll need to arrange direct billing with Medicare to avoid termination of Part B.
• If you stop paying premiums, your Part B will end, and you may face delays or penalties when re-enrolling later.

Related: Original Medicare (Parts A & B) Explained

Medicare Advantage (Part C) and Prescription Drug Coverage (Part D)

• Most Medicare Advantage and Part D plans will disenroll you automatically when you enter custody because you’re considered outside the plan’s service area.
• While you’re incarcerated, you generally cannot enroll or stay enrolled in these private plans.
• After release, you’ll have a Special Enrollment Period (SEP) to sign up for a new Medicare Advantage or Part D plan.

If You Become Medicare-Eligible While Incarcerated

People who turn 65 and already receive Social Security benefits are automatically enrolled in Medicare Parts A and B. Those who are not receiving Social Security benefits will get a mailed reminder to sign up during their Initial Enrollment Period (IEP)—a seven-month window that starts three months before the month they turn 65 and ends three months after.

Individuals in custody at age 65 will not be automatically enrolled because Social Security benefits are suspended during incarceration. They also won’t receive any mailed reminders. If you’re in custody when you turn 65, you must contact the Social Security Administration (SSA) to enroll in Medicare. Failure to enroll during your IEP can result in coverage gaps and a Late Enrollment Penalty (LEP).

After Release: Re-Enrolling or Changing Coverage

Once you’re released, you may be eligible for a Special Enrollment Period (SEP) specifically designed for people leaving incarceration.

Exceptional Condition SEP for Formerly Incarcerated Individuals

• Applies to individuals released on or after January 1, 2023.
• The SEP lasts 12 months from the date of release.
• During this period, you can:
  • Enroll in Medicare Part A and/or Part B (if eligible).
  • Rejoin or switch Medicare Advantage or Part D plans.
  • Do so without a Late Enrollment Penalty (LEP).
• If you enroll within six months of release, you may request coverage to begin retroactively—up to six months prior (but not before your release date).

If you were released before January 1, 2023, you may have to wait for the General Enrollment Period (January 1–March 31 each year) to sign up again, and late penalties may apply.

Related: AEP, IEP, ICEP, GEP, OEP, SEP…Medicare Enrollment Periods Explained

Important Notes

• Healthcare during incarceration: Even though your Medicare record stays active, correctional facilities are responsible for your medical costs. Medicare won’t pay for care provided by or through the facility except in rare cases (e.g., if the facility bills you directly and pursues collection like a private entity).
• Suspended Social Security: Benefits are suspended during incarceration for more than 30 days but can be reinstated upon release once you notify SSA.
• Consider costs vs. coverage: Some individuals temporarily drop Part B to avoid paying premiums during incarceration and then re-enroll after release under the SEP. However, you must carefully time this to avoid gaps in coverage.

Bottom Line

Planning ahead helps you maintain health coverage and avoid penalties when returning to the community.

• Before incarceration: Arrange how you’ll pay Medicare premiums.
• During incarceration: Know that Medicare entitlement continues, but the correctional facility covers your care.
• After release: Use your 12-month SEP to re-enroll or make changes to your coverage without penalty.

Stay informed, keep your premiums up to date, and communicate promptly with Social Security and Medicare to ensure a smooth transition back to care after incarceration.

Want more? Read our blog, Life Insurance for Felons: Can You Obtain Coverage with a Criminal Record?

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Colonial Penn is an insurance company and is not affiliated with or endorsed by the U.S. government or Medicare. Colonial Penn does not offer Medicare plans. The information provided relates to general insurance matters. Insurers and their representatives cannot give tax or legal advice. This article is for general educational purposes related to insurance. Seek personalized advice from qualified tax or legal advisors.

This information is for educational purposes only and is not a substitute for professional medical, legal, or financial advice. For specific Medicare questions, visit www.medicare.gov or call 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048).We strive for accuracy but make no guarantees. Policies and regulations can change. Verify information with authoritative sources and consult professionals where necessary.