By the GWAAR Legal Services Team
Here are some tips to help navigate benefits counseling with someone being released from incarceration.
Medicare
If someone does not have Medicare before being incarcerated, for example, if they turn 65 while incarcerated, they will have the 12-month Special Enrollment Period (SEP) to get into Medicare Part B (and Part A if they do not qualify for premium-free Part A) once they are released from incarceration. This incarceration SEP is available to anyone with a release date on or after January 1, 2023. The form to apply for Medicare using this SEP is CMS-10797.
If someone has Medicare before becoming incarcerated, they can keep Medicare if they continue paying the premiums. However, Medicare will not pay for claims for health care services while the person is incarcerated. Additionally, most individuals pay their Medicare premiums through their Social Security benefit check, but if they are incarcerated for longer than 30 days, they are no longer eligible for a check. Often times, then the premiums will go unpaid, and the person will be disenrolled from Medicare after the three-month grace period. However, then, upon release from incarceration, even if the beneficiary uses the incarceration SEP to reenroll in Medicare, they will have three-month grace period premiums deducted from their first Social Security benefit check. To prevent this, the person should affirmatively disenroll from Part B before incarceration and then use the leaving incarceration SEP upon release.
The individual will also need a Medicare Advantage (MA) plan with drug coverage or a Part D plan. When they are released, they will have an SEP to join a Part D plan or a Medicare Advantage Plan. Their SEP begins as early as the month before release and lasts up to two months after release. Additionally, while incarcerated, beneficiaries are considered to be outside the service area. They are not eligible for Part D and as a result, the time they are incarcerated does not count towards the Part D late enrollment penalty.
If someone misses the SEP, there may be other ways to help get them into an MA plan or Part D plan. First, if they qualify for Medicaid and/or a Medicare Savings Plan (MSP), they will qualify for the Low-Income Subsidy (LIS) and will be automatically enrolled into a low-cost Part D plan. If they have QMB, this program will pick up costs that Medicare leaves behind and full-benefit Medicaid will cover most of these costs and more, but if they only have SLMB or SLMB+, they will probably also want a Medicare Advantage (MA) plan or Supplement. To get into an MA plan, they can use the LIS SEP or any other SEP for which they may qualify.
If the individual does not qualify for Medicaid or an MSP or any of the other SEPs and they are over 65, they can apply for SeniorCare. SeniorCare counts as creditable drug coverage.
Additionally, if they are level 2b or 3 of SeniorCare, they would qualify for the State Pharmaceutical Assistance Program (SPAP) SEP and can get into an MA or Part D plan that way.
Social Security Disability Insurance (SSDI), Social Security Retirement (SSRE), and Supplemental Security Income (SSI)
Someone is not eligible for an SSI, SSDI, or SSRE benefit if they are incarcerated for more than 30 days. Sometimes, these benefits are not stopped right away, and this may result in an overpayment. Once the person is released from incarceration, their benefits can be reinstated the month following release. For SSI, if the person is incarcerated for 12 or more months, they must submit a new application.
The Social Security Administration (SSA) also has a prerelease procedure so that incarcerated individuals may apply for their benefits prior to release. (See POMS SI 00520.900 Prerelease Procedure - Institutionalization). For reinstatement information regarding Title II benefits (SSDI and SSRE), see GN 02607.840 Retirement, Survivors, and Disability Insurance (Title II) Reinstatement Policies for Prisoners.
Other Benefits
When someone leaves incarceration, they might not have income right away, or even when they do get income, they still may need assistance. It’s a good idea to do a full benefits check up to see if someone qualifies for a Medicaid program, FoodShare, Energy Assistance, or any other benefit for which they may be eligible. To apply for these benefits, someone can contact their local Income Maintenance Consortium, Aging and Disability Resource Center, and/or Elder Benefit Specialist.
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