Disability Benefits and Incarceration: Medicare and Medicaid

Do you know how incarceration impacts Medicare and Medicaid? This article is the third in our series on incarceration and disability benefits. Keep reading to learn what to expect when someone receiving Medicare or Medicaid is justice-impacted.

What are Medicare and Medicaid?

Medicare is a health insurance program for people age 65 and older and for people with disabilities who have received SSDI for at least two years. Medicare is a federal insurance program; this means the rules are same in every state.

Medicaid (called Apple Health in Washington and Oregon Health Plan or OHP in Oregon) is a health insurance program for people with low incomes and/or a disability. SSI beneficiaries are eligible for Medicaid. Some SSDI beneficiaries may also receive Medicaid.

Incarceration and Medicare

Medicare Part A (hospital) continues when someone is incarcerated. Medicare Part B (medical), Part C (Medicare Advantage), and Part D (prescription) can continue when someone is incarcerated, but they will need to keep paying their monthly premiums. If the monthly premiums are not paid, coverage will end.

Medicare General Enrollment Period

If someone’s Medicare coverage ends, they will have the option to enroll in Medicare again during the General Enrollment Period. The General Enrollment Period runs from January 1 to March 31 every year. You can enroll during the General Enrollment Period even if you are still incarcerated. When enrolling in Medicare again after your coverage ends due to unpaid premiums, you will have to pay any past-due premiums before coverage can start again. You may also have to pay a late enrollment penalty.

Medicare Special Enrollment Period

Some people may qualify for a Special Enrollment Period if they missed enrolling in Medicare because they were incarcerated. If you qualify for a Special Enrollment Period, you will not have to pay the late enrollment penalty. A free, unbiased volunteer from your State Health Insurance Program can help you understand if you qualify for a Special Enrollment Period and help you enroll.

Medicare typically won’t pay for medical bills while someone is incarcerated. Because of this, many people choose to stop paying their premiums while incarcerated. However, if you can afford to, especially if you aren’t going to be incarcerated for very long, it could be helpful to keep paying your premiums, so you avoid any gaps in coverage and late penalties.

Incarceration and Medicaid

Medicaid is administered by each state, so rules can be different from state to state. The information in this article applies to Medicaid rules in Washington, Oregon, and Idaho. However, regardless of where you live, federal law states that when someone is incarcerated, they are not allowed to be enrolled in Medicaid. When someone enters incarceration in Washington, Oregon, or Idaho, the state will suspend their Medicaid coverage.

In Washington, if you received Medicaid immediately before going to jail or prison because you were on SSI, you can start receiving Medicaid again the day you are released if you are still eligible for SSI and the jail or prison should be able to help you with this. If they don’t, you can call your local DSHS office yourself. The process to restart Medicaid could take up to 30 days in Oregon. Idaho does not provide a timeline for how long it takes to restart Medicaid benefits. The jail or prison may also be able to help you restart your Medicaid in Oregon and Idaho.

If you are no longer are eligible for SSI or if you didn’t receive Medicaid before entering incarceration, you can submit a new application when you are within 90 days of your release date through Washington Healthplanfinder or 1-855-923-4633 (in Washington), One.Oregon.gov or 1-800-699-9075 (in Oregon), or Idalink  or 1-877-456-1233 (in Idaho). Sometimes people are unable to access these websites while incarcerated because the jail or prison has them blocked. A social worker can also help you apply before you are released or you can apply after you are released.

If you have questions about your benefits, including Medicare and Medicaid, a Financial Coach at Northwest Access Fund can help!