What do incarcerated people need to know about the Marketplace?



If you’re incarcerated some special rules apply to your health care options.

Incarceration and the Marketplace

For purposes of the Marketplace, “incarcerated” means serving a term in prison or jail.

  • Incarceration doesn’t mean living at home or in a residential facility under supervision of the criminal justice system, or living there voluntarily. In other words, incarceration doesn’t include being on probation, parole, or home confinement.

  • You’re not considered incarcerated if you’re in jail or prison pending disposition of charges—in other words, being held but not convicted of a crime.

Incarceration and Medicaid

If you’re incarcerated you can use the Marketplace to apply for Medicaid coverage in your state. Medicaid won’t pay for your medical care while you’re in prison or jail. But if you enroll in Medicaid while you’re incarcerated you may be able to get needed care more quickly after you’re released.

There are 3 ways to apply for Medicaid:

  • Online, at either HealthCare.gov or your state’s Marketplace website. (Get a checklist that will help you gather needed information before you apply.)

  • With a Marketplace paper application that you fill out and mail in.

  • Directly through your state Medicaid office. Use the “Get state information” dropdown menu at the bottom of this Medicaid page to get contact information for your state Medicaid office.

State Medicaid policies and incarceration

A number of state Medicaid policies may influence your decision to apply for Medicaid while in jail or prison. These include:

  • Whether your state has decided to expand Medicaid coverage to all adults with incomes up to 138% of the federal poverty level

  • Whether incarcerated individuals can stay enrolled while in prison or jail. Remember that enrolling in Medicaid while incarcerated doesn’t allow Medicaid to pay the cost of your care while in prison or jail. But it may help you get needed care more quickly after you’re released.

Incarceration and private insurance plans

If you’re incarcerated, you can’t use the Marketplace to buy a private insurance plan. But after you’re released you can.

You may qualify for lower costs on monthly premiums and out-of-pocket costs. This will depend on your household size and income.

After you’re released, you have a 60-day special enrollment period to sign up for private health coverage. During this time, you can enroll in private health insurance even if it’s outside the Marketplace open enrollment period.

After this 60-day special enrollment period, you can’t buy private health insurance until the next Marketplace open enrollment period (unless you have another special enrollment period).

Open enrollment for 2014 coverage ends March 31, 2014. Open enrollment for 2015 coverage runs from November 15, 2014 to January 15, 2015.

If you’re incarcerated pending disposition of charges

If you’re in jail or prison but haven’t been convicted of a crime, you may use the Marketplace to buy a private health insurance plan. This assumes you are otherwise eligible to get coverage through the Marketplace.

Incarcerated people don’t have to pay the fee for being uninsured

Because you aren’t eligible to buy private health insurance through the Marketplace while in prison or jail, you don’t have to pay the penalty that some others without insurance must pay beginning in 2014.

After you’re released, you must either have health coverage, pay the penalty, or get an exemption.