Medicare Particular Enrollment Interval for Previously Incarcerated People: What Advocates Must Know

As the general inhabitants ages, the jail and jail inhabitants is growing older too. Older adults reentering our communities are disproportionately older adults of coloration, particularly Black males. The distinctive and vital disadvantages attributable to structural racism within the felony justice system and all through their lives comply with people effectively past the jail and jail partitions. In consequence, older adults leaving jail and jail are liable to being unable to entry well being care, housing, and a variety of well being and financial safety advantages that would assist them transition easily and reside securely in the neighborhood.

With assist from AARP Public Coverage Institute, Justice in Growing older is releasing a collection of difficulty briefs to make sure advocates and repair suppliers are conscious of the distinctive challenges older adults reentering the group after incarceration face and to offer the instruments they should join their older grownup purchasers to the security internet advantages they want. This primary difficulty transient within the collection discusses the Medicare Particular Enrollment Interval for previously incarcerated people.

We gratefully acknowledge Georgia Burke, previously Justice in Growing older’s Director of Medicare Advocacy, for authoring the primary version of this difficulty transient. Georgia’s ardour and thought management was foundational to Justice in Growing older’s advocacy to enhance entry to well being look after older adults leaving incarceration.

Introduction

Older adults leaving incarceration face vital challenges in connecting with healthcare advantages once they return to their communities. Getting and utilizing Medicare protection is a kind of challenges. The Particular Enrollment Interval for previously incarcerated people (“Submit-Incarceration SEP”) helps alleviate these challenges by permitting eligible people to enroll in Medicare throughout any a part of the yr and to keep away from late enrollment penalties.

Though most older adults returning to the group are additionally Medicaid-eligible, some will not be. How reentry challenges play out relies upon partially on whether or not an older grownup returning to the group additionally qualifies for state Medicaid protection.

The Medicare Submit-Incarceration SEP got here into impact on January 1, 2023 and was modified efficient January 1, 2025.^[1] It is a crucial enchancment within the means of acquiring or restoring Medicare protection. The Submit-Incarceration SEP gives vital reduction from the prior rule which required these returning to the group to attend till the subsequent accessible enrollment interval, which regularly meant ready till the Medicare Basic Enrollment Interval (January via March yearly) to enroll. The prior rule additionally imposed late enrollment penalties, even when the person was incarcerated once they first grew to become eligible for Medicare. Below the Submit-Incarceration SEP, people leaving custody now have a 12-month interval wherein to enroll or re-enroll in Medicare and might accomplish that with out being topic to a late enrollment penalty.

This difficulty transient explains the small print of the Submit-Incarceration SEP and appears at the way it interacts with different present Medicare guidelines. It gives eventualities of how Medicare enrollment performs out for Medicare-eligible people and spotlights points which may come up for people in several circumstances together with:

• These with or with out premium-free Medicare Half A
• Those that had been enrolled in Medicare previous to incarceration and those that by no means enrolled
• These additionally eligible for Medicaid protection

What Occurs to Medicare Whereas a Particular person Is Incarcerated?

Medicare enrollment can start or proceed throughout incarceration if premiums are paid, however the Medicare program stops paying for well being care providers whereas a person is within the custody of a penal authority.^[2] People who flip 65 whereas incarcerated have the proper to enroll in Medicare through the Preliminary Enrollment Interval surrounding their sixty fifth birthday, however enrolling would entail paying premiums and wouldn’t lead to any entry to Medicare providers. In consequence, many people who find themselves eligible for Medicare will not be enrolled whereas incarcerated and want an SEP to achieve entry upon launch.

What Is the Submit-Incarceration SEP?

The Submit-Incarceration SEP applies each to Medicare Half A (42 C.F.R. § 406.27(d)) (for many who don’t qualify for premium-free Half A)^[3] and Half B (42 C.F.R. § 407.23(d)).^[4] It permits people to keep away from Medicare’s late enrollment penalties for each Components A and B (whether or not they by no means enrolled in Medicare, selected to disenroll, or had been disenrolled as a result of they stopped paying their month-to-month premium).

The SEP begins on the date of launch from confinement and extends for 12 months after the month of launch. Enrollment is efficient the primary day of the month following enrollment, however people can, with cost of premiums, receive 6 months retroactive protection beginning no sooner than the primary of the month they had been launched from confinement.^[5]

People can enroll in Half D as soon as they’ve enrolled in Half A or Half B. Word, nevertheless, that retroactive protection underneath the Submit-Incarceration SEP solely applies to Half A and Half B providers. Enrollment within the Half D prescription drug profit is potential, so Medicare doesn’t cowl prescribed drugs through the retroactive interval.^[6]

People apply for the Submit-Incarceration SEP via the Social Safety Administration (SSA) utilizing utility kind CMS-10797.[7]

Who Is Eligible for the SEP?

An individual is eligible for the SEP if:

• They’ve been launched from confinement in a jail, jail, or different penal establishment or correctional facility since January 1, 2023;[8]
• That launch from confinement occurred inside the final 12 months;
• They display that they’re eligible for Medicare; and
• They display that they did not enroll or reenroll in Medicare Half B (or, if relevant, premium Half A) as a result of being confined. ^[9]

Examples

Ms. Jones was launched from incarceration in March 2025. She is eligible for the Submit-Incarceration SEP from March 2025 via March 2026 if she meets the necessities of Medicare eligibility and did not enroll or reenroll as a result of being confined.

Mr. Griffith was launched from jail in January 2025 and began 5 years of parole. He’s eligible for the SEP beginning in January 2025 via January 2026 if he meets the necessities of Medicare eligibility and did not enroll or reenroll as a result of being confined.

How Can a Particular person Show That They Have Been Launched From Confinement?

People ought to present their official launch paperwork to SSA if they’ve them. SSA additionally makes use of knowledge it collects from jails, prisons, and different penal establishments or correctional amenities and sure psychological well being establishments to find out launch for functions of figuring out eligibility for the Submit-Incarceration SEP.^[14] For individuals who have been launched from incarceration and are presently on parole, probation, or dwelling confinement, SSA knowledge ought to point out they’ve been launched. People residing in midway homes are additionally eligible for the SEP, however may have to offer documentation of their launch from confinement.^[15]

If an individual is launched from incarceration and needs to be eligible for the Submit-Incarceration SEP, however SSA doesn’t have a report of launch, the brand new SEP rule permits for SSA to simply accept different documentation of launch. This could embrace discharge paperwork or different paperwork as proof of launch.^[16] For instance, a letter from a parole or probation officer may fit as documentation. SSA additionally has a course of for serving to a person receive their paperwork of launch.^[17]

How Does Medicare Enrollment Play Out in Observe?

There are lots of permutations for older adults reentering the group, relying on their explicit circumstances. Under are eventualities that illustrate conditions that advocates could encounter when aiding their Medicare-eligible purchasers.

Alternative for Retroactive Enrollment

Mr. Carver, age 68, has been in a state jail for 5 years and has by no means enrolled in Medicare. He accomplished his sentence and was launched from custody with out supervision on February 5, 2025. Due to his work historical past, he qualifies for premium-free Half A. Though his revenue upon launch is low, he obtained an inheritance from his brother that makes his belongings too excessive for him to qualify for Medicaid.

Mr. Carver used most of his time within the first couple of months in the neighborhood working to safe steady housing and didn’t apply for Medicare till June 10, when he used the Submit-Incarceration SEP to use for Half B. His protection might start on July 1 however, as a result of he incurred 1000’s of {dollars} in medical payments in Might and June, Mr. Carver opted to pay premiums for retroactive protection again to February.^[18] As a result of Mr. Carver is eligible for premium-free Half A, he doesn’t want an enrollment interval to enroll in Half A. His half A can begin retroactively six months earlier than he utilized.^[19]

Word: Mr. Carver doesn’t have the choice of solely paying for retroactive protection for Might and June, the months wherein he incurred bills. If he chooses retroactive protection, he should pay Half B premiums for all uncovered months as much as and together with the month of launch (to not exceed 6 months complete) – on this instance February 2025.

Mr. Smith, 70, was launched with out situation on July 5, 2024. He utilized for Medicare protection on March 12, 2025, utilizing the Submit-Incarceration SEP and selected retroactive protection. His retroactive protection extends again to September 1, 2024 (the 6^th month earlier than the month of enrollment). He can not get retroactive protection past six months from the date he utilized.

Mr. Smith’s utility includes one extra wrinkle. As a result of Mr. Smith utilized in March, which is through the Basic Enrollment Interval (GEP) (January 1-March 31 yearly), his advocate ought to inform him to remember to inform SSA that he desires to make use of the Submit-Incarceration SEP and never apply underneath the GEP provisions. It’s value cautioning him since, if he applies utilizing the GEP, he’ll incur late enrollment penalties.^[20]

Different for Particular person With out Premium-Free Half A Eligibility

Mr. Ng, 66, left state jail on March 12, 2025, after being exonerated of against the law for which he served 20 years. He doesn’t meet the monetary {qualifications} for Medicaid protection and doesn’t have a enough work historical past to qualify for premium-free Half A. Mr. Ng can use the Submit-Incarceration SEP to use each for Half A and Half B protection. Nonetheless, he can not afford the steep premiums for Half A (over $500/month) and is hesitant to enroll. As a result of he isn’t entitled to free Half A, he’s eligible for Market protection as an alternative choice to Medicare. He decides that enrolling in a Market plan with subsidies is cheaper than paying each Half A and Half B premiums. He makes use of a Market SEP for people leaving incarceration, which begins the day of his launch and extends for 60 days.^[21] He additionally qualifies for Market subsidies to decrease his premiums. If he decides at some later date that he desires to enroll in Medicare as a substitute, Mr. Ng could face late enrollment penalties.^[22]

Particular person Launched to a Midway Home

Ms. Nunez, 68, who qualifies for premium-free Half A, left a carceral establishment in late February 2025. She is required to reside in a midway home for one yr. Ms. Nunez can not obtain Social Safety advantages whereas residing within the midway home, however she is eligible for Medicare. She known as SSA on March 1, enrolled in premium-free Half A, and supplied documentation of her launch to verify that she is eligible for the Submit-Incarceration SEP for Half B. She utilized in March and her Medicare Half B protection started in April. She should pay her Medicare Half B premium straight since she shouldn’t be receiving Social Safety advantages and doesn’t qualify for Medicaid.

Particular person Beforehand Enrolled in Medicare

Ms. Johnson, 75, has been in a state jail for one yr and, in August 2025, will start serving the final two years of her sentence in the neighborhood underneath dwelling detention. She was enrolled in Medicare previous to being incarcerated. Though her Social Safety advantages had been suspended whereas she was in jail, she was ready to make use of financial savings to proceed paying her Half B premiums and stay enrolled. When she returns to the group in August underneath dwelling detention, she is going to be capable of begin utilizing her Medicare advantages as a result of she is going to now not be in custody.

Mr. Lee, age 68, was already enrolled in Medicare Components A and B when he entered a carceral establishment at age 66. His Half B premium had been routinely deducted from his Social Safety profit cost. After incarceration started, his Social Safety advantages stopped and so did the automated cost of his Half B premium. After automated premium funds stopped, SSA gave Mr. Lee a three-month grace interval after which disenrolled him from Half B. He paid no consideration since Medicare was not paying for any of his well being care. When he returned to the group and his Social Safety advantages had been reinstated, he was shocked to search out that SSA had deducted the three months of Half B premiums through the grace interval from his first profit examine.⁹ This deduction is along with the common potential Half B premium deduction from the Social Safety profit.

What Occurs to Individuals Eligible for Medicaid?

Leaving incarceration works in a different way for Medicare-eligible people who, upon return to the group, additionally qualify for Medicaid. People who’re enrolled in premium-free Half A and Medicaid once they depart a carceral setting needs to be straight enrolled in Medicare Half B by their state Medicaid program, which can sometimes pay their Half B premium.^[24] Those that will not be already enrolled in Medicare Half A might want to enroll themselves and may have to make use of the Submit-Incarceration SEP to keep away from late enrollment penalties previous to getting Medicaid began. Under are some examples of the interplay of Medicare and Medicaid protection and points that advocates could encounter.

Particular person Already Enrolled in Medicare Half A and Medicaid

Mr. Broz, 66, completed serving a three-year sentence. Previous to incarceration, he had Medicaid protection via growth. His state’s coverage is to droop Medicaid throughout the complete interval of incarceration, slightly than disenroll people. Mr. Broz signed up for Medicare Half A when he turned 65, however not Half B as a result of he was incarcerated and couldn’t afford the premium. Earlier than launch, his state reviewed his eligibility and moved his suspended enrollment to the Medicaid aged and disabled (A&D) group. Since Mr. Broz was already enrolled in Medicare Half A and was low-income, the state additionally enrolled him in Half B and commenced paying his Medicare Half B premium. When he returned to the group, with solely a really small SSA profit, he continued to be eligible for Medicare and Medicaid and the state continued to pay his Half B premium. It was simple for him to “activate” each his Medicare and Medicaid advantages. He doesn’t want the Medicare Submit-Incarceration SEP. He does, nevertheless, want counseling on how Medicare and Medicaid work collectively and may benefit from help from a SHIP counselor in figuring out how he’ll entry his Medicare advantages (i.e., selecting amongst Authentic Medicare, Half D protection, and Medicare Benefit choices).

Medicare-Eligible Particular person With Medicaid Eligibility

Ms. Low, 70, qualifies without cost Medicare Half A, and although she was enrolled in Medicaid beforehand, her state disenrolled her after one yr of incarceration.^[26] She has been in a state jail for ten years and, in November 2024, started serving the final two years of her sentence in the neighborhood on parole. She enrolled in Half A and Half B (utilizing the Submit-Incarceration SEP) upon her launch from jail. Together with her small Social Safety retirement profit and no belongings, she certified for her state Medicaid program. The state began paying Ms. Low’s Half B premium in November. She makes use of Medicare as her main insurance coverage and Medicaid gives wrap-around advantages reminiscent of dental, imaginative and prescient, and transportation to her docs’ appointments.

Medicaid-Eligible Particular person Who Is Not Eligible for Free Medicare Half A

Mr. Wilson, age 80, was incarcerated in a federal jail for 60 years. He was granted parole this month. As a result of he was incarcerated at age 20, Mr. Wilson doesn’t have sufficient work historical past to qualify for premium free Half A. Previous to his launch, Mr. Wilson meets with a social employee who helps him apply for Medicaid and he’s decided eligible. As soon as launched, Mr. Wilson contacts a SHIP counselor to assist him enroll in Half A and Half B. To keep away from the steep Half A premium, he might want to use the Conditional Half A enrollment course of in order that Medicaid protection of the premium can begin on the similar time that Medicare does.^[27]

Medicaid Pre-Launch Companies

Mr. Gonzales, 75, is presently in a California state jail and expects to return to the group in two years. He has complicated medical situations, together with creating dementia, and likewise will want dwelling and community-based providers to stabilize his well being in a group setting. California has begun to supply sure pre-release Medicaid providers to excessive want people like Mr. Gonzales.^[28] Different states have utilized for waivers much like California’s to offer pre-release providers, all with the aim of enhancing care continuity and making certain higher entry to wanted care instantly upon reentry.^[29] These revolutionary waivers provide promise for vital constructive change and, if states incorporate planning particularly directed to the distinctive wants of dually eligible people, this might be a serious step in smoothing entry for Mr. Gonzales and others like him to the numerous providers essential to reside safely and have their wants met in a group setting.

Conclusion

The Medicare Submit-Incarceration SEP is a crucial step in enhancing entry to Medicare providers for people returning to the group. Justice in Growing older is accessible to offer technical help to advocates working with purchasers to navigate the reentry course of and set up steady well being care protection in the neighborhood. We additionally have an interest to study from advocates about any challenges and alternatives they’re seeing in implementation. Questions might be despatched to data@justiceinaging.org.

Endnotes

1. CMS, Reality Sheet: CY 2025 Medicare Hospital Outpatient Potential Fee System and Ambulatory Surgical Middle Fee System Ultimate Rule (CMS 1809-FC), (Nov. 1, 2024). ↑

2. Efficient January 1, 2025, the Facilities for Medicare and Medicaid Companies (CMS) narrowed its description of custody within the Medicare cost exclusion rule to use solely to people who find themselves bodily detained. Learn extra about this transformation in our truth sheet. ↑

3. If an individual is eligible for premium-free Half A, they’ll enroll at any time and they don’t face Half A late enrollment penalties. ↑

4. The Social Safety Program Operations Guide System (POMS) provision discussing the Submit-Incarceration SEP is discovered within the SSA, POMS HI 00805.386. ↑

5. 42 C.F.R. §§ 406.27; 407.23 ↑

6. See 42 C.F.R. § 423.38(a)(3)(iii); CMS Prescription Drug Advantages Guide, Ch. 3, p. 41 at 19. ↑

7. Word that as of July 15, 2025, the applying kind has not but been up to date to replicate new laws, efficient January 1, 2025. The POMS HI 00805.386 has been up to date. ↑

8. The SEP solely applies to launch dates on or after January 1, 2023, and doesn’t provide retroactive reduction of late enrollment penalties previous to that date. ↑

9. 42 C.F.R. §§ 406.27; 407.23 ↑

10. For particulars on SSA knowledge alternate with carceral establishments and the way SSA collects knowledge from different sources, see SSA POMS GN 02607.410 et seq. ↑

11. CMS, Sufferers in Custody Below a Penal Authority (June 2025). ↑

12. See CMS, Reality Sheet: CY 2025 Medicare Hospital Outpatient Potential Fee System and Ambulatory Surgical Middle Fee System Ultimate Rule (CMS 1809-FC), (“To facilitate entry to Medicare protection, CMS is finalizing our proposal to revise the eligibility standards for the particular enrollment interval for previously incarcerated people to incorporate people who’ve been launched from incarceration or on bail, parole, probation, or dwelling detention and align extra intently with the Social Safety Administration’s standards for figuring out incarceration standing. As well as, the eligibility standards shall be expanded to incorporate people launched from incarceration to residency in midway homes.”). ↑

13. 42 C.F.R. § 406.27(d)(1); 407.23(d)(1). ↑

14. See CMS.gov, How does Medicare decide if somebody is in custody underneath a penal statute or rule. ↑

15. 89 FR 94512 (“[A]s SSA methods could not establish people in midway homes as now not in confinement, these people will seemingly want to offer documentation of discharge to SSA proving that they’ve been launched from incarceration to affirm eligibility for this SEP.”), https://www.federalregister.gov/d/2024-25521/p-5225. ↑

16. 89 FR 94513 (“[W]e are revising our language at proposed §§406.27(d)(2)(i) and 407.23(d)(2)(i) to exchange the time period ‘‘discharge paperwork’’ with ‘‘documentation of discharge.’’ This may permit people who could not have particular discharge paperwork, however produce other proof of their discharge, the flexibility to make use of the SEP.”) ↑

17. SSA POMS GN 02607.840 Retirement, Survivors, and Incapacity Insurance coverage (Title II) Reinstatement Insurance policies for Prisoners. ↑

18. Mr. Carver can join premium-free Half A anytime; he doesn’t want an enrollment to enroll. His Half A might be retroactive six months. ↑

19. CMS, Authentic Medicare (Half A and B) Eligibility and Enrollment. ↑

20. SSA, POMS HI 00805.382.C. ↑

21. CMS, Understanding the Well being Insurance coverage Market if You’re Incarcerated (Jan 2025). ↑

22. CMS, Steadily Requested Questions Concerning Medicare and the Market, at A.6. and A.9 (Apr. 28, 2016). ↑

23. CMS, Sufferers in Custody Below a Penal Authority (June 2025). ↑

24. Medicaid pays Half B premiums for most individuals dually eligible for Medicaid and Medicare. Medicaid pays the Half B premium if: (1) The individual is in a Medicare Financial savings Program like Certified Medicare Beneficiary (QMB), Specified Low Revenue Medicare Beneficiary (SLMB), or Qualifying Particular person (QI); (2) The individual is in a Medicaid eligibility class that’s within the state’s purchase in class; or (3) The state is requiring Medicare enrollment as a requirement of Medicaid eligibility. Chapter 1 of the Medicare Guide State Fee of Medicare Premiums ↑

25. 42 USC 1396a(a)(84)(B) (requiring states to redetermine eligibility previous to launch for sure ”eligible juveniles”) and Part 206 of the Consolidated Appropriations Act of 2024 (directing the HHS Secretary to award state planning grants to enhance continuity of care, together with establishing normal procedures for renewing protection whereas incarcerated); see additionally CMS, State Planning Grants to Promote Continuity of Take care of Medicaid & CHIP Beneficiaries Following Incarceration. ↑

26. Word that, beginning in January 2026, all states shall be required to droop, slightly than terminate Medicaid protection throughout incarceration. Part 205 of the Consolidated Appropriations Act of 2024; see additionally HARP, Medicaid’s New Position in Advancing Reentry: Key Coverage Change, (Spring 2025) ↑

27. Justice in Growing older, Reality Sheet: Medicare Half A Conditional Functions (Jan. 28, 2025). ↑

28. California has established a state webpage on its actions in planning and implementation of its waiver: https://www.dhcs.ca.gov/CalAIM/Justice-Concerned-Initiative/Pages/dwelling.aspx ↑

29. CMS launched steerage via a State Medicaid Director Letter, SMD 23-0003, (Apr. 17, 2023) to states on designing demonstration initiatives underneath Part 1115 waiver authority. For an outline of pending state waivers see, KFF, Part 1115 Waiver Watch: Medicaid Pre-Launch Companies for Individuals Who Are Incarcerated, (Aug. 19, 2024). ↑