Natalie Kean: Hello everyone and welcome to today’s webinar presentation entitled Access to Medicare for People Leaving Incarceration. My name is Natalie Kean and I’m the director of Federal Health Advocacy on the health team at Justice in Aging. I’m joined today by my colleague Rachel Gershon, a senior attorney also on our health team. Before we begin, I would like to go over a few webinar logistics. All participants are on mute, but we welcome your participation in today’s presentation through the Q&A function in the Zoom control panel. Also available in the Zoom control panel, is the CC button, which enables closed captioning. We will be watching the participant questions as they come in throughout the webinar and we will uplift high-level themes during the Q&A segment at the end of today’s presentation. We will address questions we don’t get to during today’s webinar via email. You can also use the Q&A function to request technical assistance with Zoom, and our staff will do our best to assist you.
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Before we begin the content of today’s presentation, we wanted to share a little bit more about Justice in Aging. We are a national organization that uses the power of law to fight senior poverty by securing access to affordable healthcare, economic security, and the courts for older adults with limited resources. Since 1972, we’ve focused our efforts primarily on fighting for people who have been marginalized and excluded from justice such as women, people of color, LGBTQ+ individuals and people with limited English proficiency. Justice in Aging is committed to advancing equity for low-income older adults in economic security, healthcare, housing, and elder justice. We strive to address the enduring harms and inequities caused by systemic racism and other forms of discrimination that uniquely impact low-income older adults in marginalized communities.
Justice in Aging provides a wealth of information like the webinar you are viewing today. We also create fact sheets, issue briefs, alerts, and other materials to keep you up to date with important developments. If you’re not already a member of our network, we encourage you to join by going to our website and signing up or by emailing info@justiceinaging.org. And now we’re ready to provide an overview of what we will talk about today. So Rachel is going to begin with some background on older adults and reentry and particularly access to healthcare for older adults who are leaving incarceration. She will go over enrolling in Medicare at reentry and then we’ll talk more about access to Medicare once someone is enrolled. And this is particularly important for people who are required to be under community supervision. Finally, we’ll talk about considerations for people who are dually eligible for both Medicare and Medicaid at reentry. And we’ll save some time at the end of the webinar for questions. And with that I will turn it over to Rachel.
Rachel Gershon: Thank you so much, Natalie. I am pleased to be giving this presentation today. So we’re going to start with kind of a background overview of older adults and reentry. Next slide, please. So we’ve been seeing that nearly a quarter, so one in four of all individuals in prison are over 50 years of age, and this number has been rising for years. It’s partly an effect of the mandatory minimums and harsh criminal justice policies that were enacted in the ’90s and early 2000s. Older adults in prison face more mental and physical health challenges than their community dwelling peers, including higher rates of cognitive issues and more issues with navigating activities of daily living. Once a person leaves jail or prison, access to healthcare is essential, especially for older adults addressing physical, mental, and long-term care needs. And we especially know that this is important in the first few weeks after release from incarceration to immediately get access to medications, to services, to mental health treatment is really important for establishing a person in the community and helping them live their full life. Next slide.
So why is Medicare important for reentry? So one of the main paths for a person leaving incarceration is Medicaid. We often hear about Medicaid, which is the health insurance for low income individuals in America. Another program, Medicare is also very important. A person can be on Medicaid alone, they can also be on Medicare alone, or both at the same time. So Medicare is a federal health program. It’s available to individuals age 65 and over and also available to certain people with disabilities under the age of 65. Medicare may be the only coverage that an older adult is eligible for. Medicare can cover many services for older adults and it has a wide provider network.
So including some services like substance use disorder treatment, mental health, prescription drugs, hospital, outpatient, a wide range of services. When compared to Medicaid, Medicare can offer a wider provider network in most states. And Medicare is designed to start when a person first becomes eligible, even if the person becomes eligible while incarcerated. Late enrollment can trigger late enrollment penalties and we’ll talk later in this presentation about how to avoid those late enrollment penalties even if a person does not sign up right away. And then finally, as I mentioned, individuals can enroll in both Medicaid and Medicare at the same time. Next slide.
There’s been some recent improvements to Medicare at reentry. There’s a new rule that was finalized late last year to improve access to healthcare for older adults and people with disabilities. These changes narrow Medicare’s definition of custody and removes enrollment barriers. So for example, it allows people to live in the community under supervision like parole and probation and still access Medicare. It aligns Medicare policy with Medicaid policy, which is really helpful when designing reentry programs that work for both. And it saves money for state Medicaid programs by making Medicare available when a person is eligible for Medicare. Next slide.
Now I’m going to turn to the specific task of enrolling in Medicare after reentry. Next slide. As I mentioned before, Medicare has restrictions for when a person can enroll. You can’t just enroll in Medicare every week of the year, for example. You can enroll during an initial enrollment period, which is the seven months around when a first a person first becomes eligible, like when they turn 65. You can enroll during the general enrollment period of January through March each year. However, enrolling during general enrollment can lead a person subject to late enrollment penalties. And then finally, if you fit into a specific category, you can be eligible for what’s called a special enrollment period, which is a specific time when a person can enroll often without late enrollment penalties. So that’s really important for avoiding those late enrollment penalties. Next slide.
So late enrollment penalties can happen on many parts of Medicare’s premiums. So enrolling late after that initial enrollment can trigger late enrollment penalties. People who use special enrollment periods can generally avoid late enrollment penalties. One of the most common penalties is on Part B, outpatient services and it adds 10% for each year that you’re late enrolling. Next slide. So I’ll give an example of Jerry. So Jerry turned 65 in January 2023 while he was incarcerated. He did not enroll in Medicare Part B, he was released in 2025. If Jerry enrolls in Medicare using the general enrollment period and not a special enrollment, he would owe $222 a month in Part B premiums representing a 20% late enrollment penalty for enrolling two years late. If Jerry enrolls instead using a post-incarceration special enrollment period, he would owe $185 a month in Part B premiums and this late enrollment penalty, the $222 will last throughout when he’s enrolled in Medicare, so it’s quite significant. Let’s go to the next slide.
So the special enrollment for post incarceration can be used for Part A, in particular people who have to pay premiums for Part A. Part B, which everyone has to pay premiums for Part B, So that’s much more widespread. Individuals are eligible for the post-incarceration special enrollment period if they’ve been released from confinement in a jail, prison, or other penal institution or correctional facility within the last 12 months. They are eligible for Medicare and they failed to enroll in Medicare due to being confined. Let’s go to the next slide. Individuals who’ve been released from confinement within the past year are eligible. You can be released to the community without supervision and be eligible for the special enrollment. You can also be released with supervision, so on parole or probation and be eligible for SEP, including those on probation parole, if you’re subject to home confinement, or residing in a halfway house. Next slide.
To apply for the special enrollment period, you can use the social security application form 10797 which is available online and individuals can also using the post-incarceration SEP, special enrollment period, can access Medicare Part A or Part B retroactively, but have to pay premiums. If using post-incarceration special enrollment period, there’s no late enrollment penalties for Part A and B. Let’s go to the next slide. The Social Security Administration collects data from jails, prisons and mental health institutions and other entities to determine when a person has been released from confinement. For a person who has been released from incarceration, confinement, and are currently on parole, probation, or home detention or confinement, SSA data should indicate that they have been released and therefore if it’s been within 12 months, they’re eligible for this special enrollment period. Individuals who are in a halfway home or are eligible for the special enrollment period, if they were released from confinement within the last 12 months, they may have additional paperwork challenges with the SSA. We’re still waiting to hear how that works. Next slide.
If the Social Security Administration does not have data showing release, there is a pathway. So the new special enrollment period rule allows for the centers for Medicare and Medicaid services, CMS, to accept other documentation of release and this can include discharge documents or other documents as evidence of release and we put the sites there for the specific sites and SSA can also accept these documents. Next slide. So to give an example, Mr. Carver, age 68 has been in state prison for five years. So he turned 65 while he was incarcerated. He’s never been enrolled in Medicare. He completed his sentence and was released from custody without supervision on February 5th, 2025.
Because of his work history, he qualifies for premium-free Part A. So that means he doesn’t pay a premium for that part, a hospital insurance and he’s not going to be subject to lead enrollment penalties on Part A hospital insurance. Although his income upon release is low, he received an inheritance from his brother and that makes his assets too high for him to qualify for Medicaid, though Medicare is looking like it might be his only option. Let’s go to the next slide. So Mr. Carver used most of his time in the first couple months in the community working to secure stable housing and he didn’t apply for Medicare until June 10th. He was able to use the post-incarceration special enrollment period to apply for Part B coverage and his coverage could begin on July 1st, but because he incurred thousands of dollars in medical bills in May and June, Mr. Carver opted to pay premiums for retroactive coverage back to February and that covered his care.
A note, since Mr. Carver also is eligible for premium-free Part A, he can sign up at any time for premium-free Part A. So he does that at the same time he applied for Part B. He does not need an enrollment period for premium Part A, and his Part A can start six months retroactively and just regular rules for Part A sign-up. Next slide. A note that Mr. Carver does not have the option of only paying Part B retroactive coverage for May and June, the months in which he incurred expenses. If he chooses retroactive, he must pay premiums for all uncovered months up to and including the month of release, but not six months. It’s a little complicated, but the main story is that applying for retroactive coverage has some rules around it requiring a certain number of months to sign up. Next slide.
A note about Part D as in dog. This is Medicare coverage of medications that you get at a pharmacy. Individuals can enroll in Medicare Part D prescription coverage once they have either Part A or Part B, and they don’t need a special enrollment period. Note that Part D coverage is not retroactive. And then finally, the low-income subsidy is available to help with premiums, cost sharing, and if a person is enrolled in low income subsidy, they can avoid late enrollment penalties on that Part D premium. Next slide. So that is the section on how to enroll in Medicare after release from incarceration. Now I’m going to turn it over to Natalie for Medicare for people under community supervision. Thank you.
Natalie Kean: Thank you so much, Rachel. So as Rachel mentioned, Medicare recently changed its rules that specifically impact people who are released from jail or prison but still under some sort of supervision. And when it comes to incarceration, the reason why this is important is that being enrolled in Medicare does not necessarily mean Medicare will actually pay for care or services. So Medicare rules generally prohibit payment when another entity such as a jail or prison is responsible for the individual’s healthcare costs. And the threshold Medicare applies to decide when it should pay or not is whether the person is in custody.
Thankfully, who Medicare considers to be in custody is now much more narrow than it was previously. So as of January 1st of this year, custody is now based on being physically confined. So that includes physical confinement in jail, prison, penitentiary, or a similar institution. It also includes being outside of a carceral institution while on medical furlough. It includes being escaped from confinement and it includes being required to reside in a mental health facility under a penal statute or rule. So under this new rule, the first list on this slide of people in custody are people that Medicare presumes someone else is covering the cost of care and will not pay for care even if a person is enrolled.
Now, the new rules consider people who are living in the community under supervision to not be in custody. So therefore, Medicare payment is allowed for people, including those who are released to the community pending trial, that includes people in pretrial community supervision, and people released pursuant to cash bail. It includes people who are on parole, on probation, people who are under home detention or home confinement. And it also includes people who are required to reside in halfway houses or other community-based transitional facilities. Neither of these lists are exhaustive, but having the categories of people who are not in custody is really helpful because there was a lot of ambiguity before about payment and it was difficult for people who were in fact eligible for Medicare and maybe even enrolled to access their Medicare coverage. So these changes to the custody definition are welcomed and important.
So let’s walk through a few examples here. Ms. Nunez is 68 years old and left a carceral institution in late February 2025. She is required to live in a halfway house for one year. Because she’s required to live in a halfway house, she cannot actually receive her social security benefits, but under the new rules she is eligible for Medicare. So what does Ms. Nunez need to do? When she is released, she calls the Social Security Administration to provide documentation of her release and confirm that she is eligible for the special enrollment period that Rachel talked about. She uses that SEP to apply for Medicare in March and her coverage began April 1st. She also enrolled in a Medicare Part D plan for prescription drugs and that coverage began in April as well.
Because Ms. Nunez is not receiving social security benefits while residing in the halfway house, she needs to pay her Part B premium directly. So this coverage has been really important for Ms. Nunez. She was able to get her Welcome to Medicare visit, fill her prescriptions and get treatment for a knee injury that she has had for some years. Had Ms. Nunez been released last year or earlier, she may not have been able to enroll in Medicare and she could have faced, even if she did get enrolled, she could have faced payment issues because of Medicare’s previously broad custody definition. And so this is a good example of the difference that this rule change has made.
So now we’re going to walk through some considerations and examples for people who are duly eligible for both Medicare and Medicaid. As Rachel talked about at the beginning, again, many people leaving incarceration are eligible for Medicaid because they have little income and savings, but people can also be eligible for both Medicare and Medicaid at the same time. And these people are known as dual eligible or sometimes referred to as duals. Medicaid is a really important additional benefit for people with Medicare. It can help make Medicare affordable by covering premiums and in some cases, cost sharing. Medicaid also covers a lot of benefits that Medicare doesn’t. Most importantly, long-term care. So this includes long-term stays in nursing facilities as well as a wide range of home and community-based services on an ongoing basis. It also can cover other wraparound benefits depending on the state, things such as dental, vision, and hearing. People who are eligible for Medicaid, depending on the situation may not need the post-incarceration SEP.
So Medicaid eligibility and enrollment can impact Medicare enrollment and vice versa. Factors that impact whether and how a person enrolls in Medicare or Medicaid include whether they’re currently enrolled in either Medicare or Medicaid, whether they’re receiving social security benefits, and whether they are entitled to premium-free Part A or required to pay a premium for their Part A coverage. So let’s walk through a few examples to illustrate. First is Mr. Broz. He is eligible for premium-free Part A and he’s already enrolled in Medicaid. He is 66 years old and finished serving a three-year sentence. Mr. Broz enrolled in free Part A when he turned 65 while he was imprisoned. Prior to incarceration, he had Medicaid coverage through expansion. His state’s policy is to suspend that Medicaid coverage during the entire period of incarceration rather than disenroll.
So prior to Mr. Broz’s release, his state Medicaid program moved his suspended enrollment from the expansion Medicaid category into the Medicaid Aged and Disabled group because he had turned 65 and was no longer eligible for expansion. Upon release, Mr. Broz’s state enrolled him in Part B of Medicare and began paying his Part B premium. He was already enrolled in Medicaid and already had his Medicare Part A started so it was very easy for Mr. Broz to turn on both his Medicare and Medicaid benefits and he does not need to use the Medicare post-incarceration SEP.
Now as a different example, Ms. Low is eligible for both Medicare and Medicaid, but she is not enrolled in either program. Ms. Low is 70 years old and was in state prison for 10 years. And in November of last year, she began serving the last two years of her sentence in the community under parole. So even though Ms. Low was previously enrolled in Medicaid, her state’s policy was to disenroll her after one year of incarceration. So she is no longer enrolled in Medicaid. Upon release, Ms. Low calls SSA and enrolls in free Medicare Part A. She had sufficient work credits to be eligible for free Part A and she used the post-incarceration special enrollment period to enroll in Part B. Now, Ms. Low has just a small social security check as her income and she doesn’t have any savings or other assets, so Ms. Low also applied for her state Medicaid program upon release. Her state enrolled her in a Medicare Savings Program and started paying her Medicare Part B premium right away.
Now we’ll take a look at Mr. Wilson who is not eligible for premium-free Medicare Part A. Mr. Wilson is 80 years old and was incarcerated in federal prison for 60 years. He was granted parole this month. Because Mr. Wilson was incarcerated at age 20, he does not have enough work history to qualify for premium-free Part A. Prior to his release, Mr. Wilson meets with a social worker who helps him apply for Medicaid and he is found eligible. Once released, Mr. Wilson contacts a SHIP counselor in his state to help him enroll in Medicare Part A and Part B. Now, because Mr. Wilson doesn’t have work history to qualify for free Part A, he faces a steep Part A premium, it’s over $500 a month in 2025. But he can avoid this premium by using his Medicaid coverage and he needs to work with an advocate to use something called the conditional part A enrollment process so that his Medicaid coverage of the premium for Part A can start at the same time that his Medicare does.
So those are examples. As you can tell, and I think Rachel mentioned, it can be quite complicated that we have some helpful resources including our issue brief on the special enrollment period that we have updated with the examples we shared today and more examples as well as a lot of really practical tips for advocates to use to help people get enrolled and use their Medicare coverage. We also have a short fact sheet explaining the changes to Medicare’s custody definition and what that means for older adults leaving incarceration. Justice in Aging also does a lot of work on access to other benefits for older adults leaving incarceration, including social security, SSI, and housing benefits. And so the third link here is to all of our resources on reentry for older adults. And through the National Center on Law and Elder Rights, we have a whole bunch of trainings on Medicare basics and advanced topics as well as Medicaid and information on people duly eligible for both.
So we really encourage advocates to use those resources. They’re all free and available. And then the Centers for Medicare and Medicaid Services just recently released a pamphlet for providers, for Medicare providers entitled Patients in Custody under a Penal Authority. And although it has a dry title, it is a wonderful resource that really outlines from Medicare’s perspective, these rules. And in our issue brief, we cite a couple of places where you can use this document to help your clients get access to their Medicare coverage. So for example, it might be helpful for a client to bring this with them to a doctor’s visit to assure the doctor that they are enrolled in Medicare and can use their Medicare coverage even though they are on parole, for example. And so with that, I think we have plenty of time for some questions. Rachel, do you want to kick things off?
Rachel Gershon: Oh, absolutely. So in a minute… Is there echo? Oh, no. Okay. Oh, great. Thank you, Natalie. So in a minute I’m going to ask Natalie to talk about people who become eligible while they’re incarcerated, all sorts of things like, should you sign up? What happens if you stop paying your premiums? What happens once you leave? But I’ll give Natalie a minute to gather herself after that great presentation. And I’m going to answer a number of questions that came up around affordability and how does a person manage to access Medicare with their premiums for Part B and Part D following incarceration. So in general, as many of you know on this call, there are Medicaid programs called the Medicare Savings Program. They go by a lot of different names, but they can help pay for Part A premiums if you have to pay a Part A premium, Part B premiums. And sometimes they pay for cost sharing too, so like deductibles, co-payments, co-insurance. We have other materials on Medicare Savings Programs that go into the details.
But a quick answer is yes, a person re-entering into the community can apply for those Medicare Savings Programs. Some of the Medicare Savings Programs will be retroactive for three months if you’re eligible during that time, some others are not. So it gets a little complicated for this webinar. But in general, there are Medicare Savings Programs available for payment of premiums and sometimes cost sharing after re-entry. There is also, as I mentioned, low-income subsidy, also known as Extra Help that can help pay for Part D, the medication premiums and also help with some of the cost sharing as well. A lot of astute people in the question and answers noticed that the special enrollment period doesn’t help you with Part D late enrollment penalties. That’s where this low-income subsidy Extra Help can really help with that late enrollment penalty as well. So now I’m going to turn it to Natalie to talk about a range of questions of when a person becomes eligible for Medicare while incarcerated or comes in with Medicare, what happens with premiums, getting services paid while incarcerated and once you leave?
Natalie Kean: Sure. So yeah, I saw some of these questions and I think just some basic information that would be helpful to answer a lot of them is that being incarcerated does not prevent you from being enrolled in Medicare. But the payment rules that I talked about do prevent Medicare from paying for coverage for people who are in custody. And now that means people who are in physical custody in a jail or prison. So you can be enrolled in Medicare, but Medicare may not pay for your services. If you are entitled to premium-free Part A, that enrollment can continue while you are incarcerated. If you become eligible for premium-free Part A during incarceration, that would take some action on your part during your initial enrollment period to get that started because you’re not receiving social security benefits.
So that is not automatically triggered. Now if you want to enroll or stay enrolled in Medicare Part B, your premiums would have to continue to be paid in order to keep enrollment going during incarceration. And so I think just a thing to know about this is the special enrollment period is really important because many people cannot afford to pay a Medicare Part B premium while they are incarcerated and so they are not enrolled in Medicare. And so this special enrollment period gives people that opportunity to enroll in Medicare whether they were enrolled previously or missed their initial enrollment period because they were incarcerated. Rachel, is there anything you’d like to add or another question?
Rachel Gershon: That was great, thank you. And I will add, and forgive me if you said this, I was reading questions so I may have missed it. If a person leaves incarceration and finds out, oh no, I owe three months of premiums for my Part B because I went into incarceration with Part B, there was a grace period where they gave you time to pay your premiums and then they cut you off, but you still owe those three months. There are pathways available for asking for a waiver, for asking for an installment plan even if that money has already been taken out of a social security check. So we have resources around that and are happy to share about what to do with past due premiums for Medicare. I’m going to ask Natalie kind of a basic question of, so for Medicare and Medicaid, do you have to be 65 years or older or are there other pathways to those coverages?
Natalie Kean: There are other pathways. For Medicaid, there are many other pathways to coverage, but the uniform rule around Medicaid is that you have limited income and resources. So it’s not only based upon your age or disability, but also your income and savings. For Medicare, you can be eligible if you are younger than 65 and disabled and that is a process that goes through the Social Security Administration. When someone is determined disabled under the social security rules, there is generally a two-year waiting period before Medicare coverage begins.
Rachel Gershon: Thanks so much. So no, you do not have to be 65 years or older to be on Medicaid or Medicare. There was a question that came up that asked, “Who do we ask for help?” This is a complicated program. My advice is to get to know your SHIP counselors in your area as a first step, State Health Insurance Assistance Programs. They can go by many different names. You can find them online at shiphelp.org and they are free, unbiased advice on Medicare issues. In addition to SHIP counselors, many states have reentry programs including reentry counselors that help people sign up for health insurance. So that is also a good resource to go to. I’m going to answer one more question before I turn over to Natalie about how does the reconciliation bill that just passed, how does that affect Medicaid assistance with Medicare premiums, those Medicare Savings Programs that I mentioned.
So while the reconciliation bill does affect some rules that require states to make it easier to enroll in those programs, the bill does not affect eligibility for those programs. So if you’re eligible, if you would’ve been eligible before the bill comes into effect for those Medicare Savings Programs, those programs that help you pay for Medicare eligibility, you would still be eligible after the bill comes into effect. Natalie, are you seeing some questions you want to answer or do you want me to throw you a question or two?
Natalie Kean: I saw some questions about if you’re in a halfway house and you can’t get social security benefits, how can you pay for your premiums? That is a great question that the rule change that we’re talking about does not solve for, but just to clarify, there is some difference between eligibility for social security, retirement benefits or other benefits and Medicare eligibility and payment. So one of those differences right now is people who are required to reside in halfway houses may not be eligible for their social security benefits, but they can be eligible for Medicare and for Medicaid. So if someone is residing in a halfway house, they may have employment and could use that income to pay their Part B premium. But if they’re low income and meet their state’s eligibility criteria for the Medicare Savings Programs for example, they could get help with those Medicare premiums. So that is another option, but it’s true, there may be some people who are still stuck not being able to afford coverage.
Rachel Gershon: Yeah, and just flagging that the Medicare and Medicaid rules for halfway houses are a little different. So you might run into some issues there. I saw some questions more about conditional Part A, and I’m just going to give a broad overview of why conditional Part A is important and note that we have additional about conditional Part A. So in many cases we see a person who is eligible for Part A hospital insurance, but they have to pay a premium and they are also eligible for their state to pay for that premium. And the big question is how do they get enrolled and have the state pay for that help at the same time that they get enrolled into Medicare Part A?
And the conditional Part A process helps you go to social security first, sign up for conditional Part A. So you’re not actually covered under Part A at that point. It’s just it’s ready to be turned on as soon as your state approves you for that Medicare Savings Program help with the Part A premium. So that’s kind of the broad overview of why we talk about conditional Part A process sometimes and we have additional resources for how to work through that process. And I’m happy to answer more questions or turn it over to Natalie if she has them.
Natalie Kean: Yeah, I saw one that maybe you had already queued up for yourself Rachel, but how long after release from incarceration does the special enrollment period run?
Rachel Gershon: Absolutely. So it runs 12 months after release from incarceration. So let’s say you leave prison in January and you’re on probation for the next three months. The start of your special enrollment period is in January when you leave that incarceration even though you’re going to supervision. So you’d be eligible for that special enrollment period for a full year after that January time period.
Natalie Kean: Thanks. And then there’s a question about the enrollment application for the special enrollment period. Someone said they saw it online and it still looks like it has old information. Has that been updated?
Rachel Gershon: It has not been updated yet. We are hopeful that it will be updated. So we really encourage you to bring that CMS, that new Medicare learning program resource that just published this week talking about the special enrollment period. So you can bring that to Social Security to show how this works. There’s also some social security guidance, they’re called the SSA, for Social Security Administration, POMS. And we have those specific references in some written materials that will come out after this webinar to bring with you. But we do acknowledge that that application is still referencing old definitions of incarceration that may be confusing for folks.
Someone asked what happens if they could sign up for a Medicare Advantage plan, that we didn’t really talk about. And in general, to sign up for a Medicare Advantage plan, you need to be on Part A and B. So that kind of follows. Once you’re on Medicare Part A and B, you can sign up for a Medicare Advantage plan. There are specific times when you can sign up for Medicare Advantage as well. So we hear about the enrollment periods for signing up for Medicare. There’s also enrollment periods for signing up for Medicare Advantage. It uses a lot of the same language including there’s special enrollment periods for signing up for Medicare Advantage and there’s resources out there for that. But we’re happy to follow up with any specific questions around Medicare Advantage.
Natalie Kean: That’s great. Yeah, I saw a question about what you just referenced, the SSA guidance is the POMS, P-O-M-S. So that instructs people working at SSA on how to process these applications and various situations that people may call in about.
Rachel Gershon: Wonderful, thank you. I’m looking at new questions. There’s LIS, question mark. That stands for the low-income subsidy. It’s often also called Extra Help. So it’s both an acronym and has numerous names for it and LIS, low income subsidy, also known as Extra Help is a program administered through the Social Security Administration and it helps with your Part D medication premiums and cost sharing. There’s also a question, I’m just going to read it and answer it. “If a person is already enrolled in Medicare, so they’re age 67, they go to prison for two years, will they owe the premiums from during that time? So are they going to come out of prison owing two years of premiums?” The short answer is no.
So if you have Part B and you’re paying premiums on that Part B and you’re incarcerated and you don’t pay premiums, Medicare will wait for three months just in case you’re going to pay premiums and then they will shut off that Part B. And after they shut off that Part B, won’t owe premiums after that. But when you get out of incarceration, you may find that you owe those Part B premiums and it’s called past due Medicare premiums. And there’s a number of options for dealing with that for those three months of premiums that a person didn’t pay. And we have written resources about that.
Natalie Kean: There’s a question about, “Can you call your local social security office to get help with first steps?” Yes, we do recommend for those of you on this webinar to use the resources on the slide here to help you be ready to help the Social Security Office understand the special enrollment period and which section of the guidance and things that they should be looking at. And just to note too, Rachel gave an example at the beginning of someone who if they enrolled during the general enrollment period would face late enrollment penalties, but using the special enrollment period, they don’t.
And so it’s very important, especially if someone is enrolling during the general enrollment period, January through March, that it’s clear to SSA that they are using, that they want to use the special enrollment period. Another resource and also for post-enrollment issues with payment and things like that is 1-800-MEDICARE. They can connect you with the Medicare Beneficiary Ombudsman office. And then Rachel and I are also available to help with technical assistance and are certainly interested to hear about any particular issues that folks are having. Rachel, were there any last questions you wanted to answer?
Rachel Gershon: Yeah, I have a last question I want to mention. I’m so grateful for all the questions that have come in and I know that we haven’t addressed all of them. And in particular, there’s some specific questions like this particular place, is that considered incarcerated or not? And we will do our best to get out to you the best of our knowledge answer on these questions as they come up. So there’s a question, “How long do you have to pay the penalty, the late enrollment penalty, for Part B? Please explain.” So unfortunately, the late enrollment for Part B lasts for as long as you have Medicare.
However, there are a few ways to avoid it if you’re enrolling late. One way is to use a special enrollment period. Another way is some of these Medicare Savings Programs, the state will pay that late enrollment penalty for you, or CMS will not charge it depending on the state you’re in. And depending on the state you’re in, sometimes even after you’re no longer eligible for that Medicare Savings Program, you won’t have that late enrollment penalty. And we’re happy to answer specific technical assistance on the ins and outs of this complicated program. So it looks like we’re nearing the end. I will hand it off to Natalie for any last questions.
Natalie Kean: Yeah, thank you, Rachel. And thank you everyone for joining us today. As I said, feel free to reach out to Rachel and me with any additional questions and please don’t forget to complete the post webinar survey. Your feedback on our webinars is really important to us and helps us inform what other trainings and resources we can be providing. I hope everyone has a great rest of your day.
