Section 1862(a)(2) and (3) of the Social Security Act generally prohibits Medicare
payment for covered services while the recipient is incarcerated, as the incarcerated
individual is provided healthcare through their penal institution (see HI 00620.070C). Further, section 202(x)(1)(A) of the Act prohibits the payment of Old-Age, Survivors,
and Disability Insurance (OASDI) benefits to individuals who are incarcerated (see
GN 02607.160).
For example, if an individual turns 65 and qualifies for Medicare while incarcerated
(meaning the individual is in custody of penal authorities as described in this POMS)
and is not yet receiving OASDI benefits, that individual is not automatically enrolled
in Medicare Part A. If these formerly incarcerated individuals do not enroll or reenroll
into Medicare, they may go months without health insurance coverage upon their release.
For example, upon their release such individuals would only be able to enroll in Medicare
during the General Enrollment Period (GEP) which could result in a significant delay
in coverage. Further, delaying enrollment means that they may incur a premium surcharge
for premium Part A and/or a premium surcharge for Part B for the rest of their lives.
These instructions provide an SEP for these individuals. These only provide provisions
for incarcerated individuals released on or after January 1, 2023 a special enrollment
opportunity. Individuals released prior to January 1, 2023 are not covered under the
regulations.