Medicare for Immigrants & Non-Citizens: Who Qualifies and How

Medicare for immigrants comes down to two questions: whether you hold an eligible status, and then whether you have enough work history or 5 years of continuous residence here. A 2025 law set which four statuses count. Within them, 40 quarters of work (about 10 years, yours or a spouse's) brings premium-free Part A at 65, and a green card holder 65 or older without that record can buy in after 5 straight years living in the country. So if you or a parent came here later in life with a green card, Medicare is often not off the table.

Medicare for immigrants: the four eligible categories

Sorting out a benefit you've never had access to, often on a parent's behalf, is genuinely hard. The rules are knowable, though, and they start with one threshold question before work history or residence enters the picture: what is your immigration category?

As of a 2025 federal law, only four categories of people can be entitled to or enrolled in Medicare. Under section 1899C of the Social Security Act, the section that law added (it appears in federal code as 42 U.S.C. 1395mmm), an individual may be in Medicare only if they are:1

• A citizen or national of the United States.
• An alien lawfully admitted for permanent residence, meaning a green card holder.
• A Cuban or Haitian entrant.
• An individual lawfully residing under a Compact of Free Association (COFA), which covers citizens of the Marshall Islands, Micronesia, and Palau living in the U.S.2

The test is the status a person holds, so a visitor visa, a temporary work visa, a G-4 visa, or any other status that isn't one of those four does not qualify on its own.1

For most immigrant families sorting out a parent's coverage, the relevant category is the second one: green card holder. If that's your situation, the two paths below decide how you qualify for Medicare. Lawfully present immigrants who fall outside these four categories are covered under "Which immigrants can no longer get Medicare" further down.

Path 1: You (or your spouse) worked here for about 10 years

This is the most straightforward situation, and it's more common than people expect. If you're a green card holder who is 65 or older and you have at least 40 quarters of Medicare-covered work, about 10 years, you qualify for premium-free Part A on the same basis as a U.S. citizen.3 Forty quarters is the usual route, not the only one: federal law counts some work records another way, most often for someone whose working years were interrupted by a disability, so if you come up short, ask Social Security to check your record before assuming Part A can't be free. For a non-citizen, the law adds one condition: you must have been assigned a Social Security number in line with its work-authorization rules, or have earned the credits while lawfully admitted temporarily for business or as a crew member.3

You can also qualify on a spouse's work record, including a current, former, or deceased spouse who met the 40-quarter threshold. So a person who spent those years raising a family rather than in paid work may still qualify through their husband or wife.1 A former spouse's record generally counts only if you were married at least 10 years and aren't currently married; a late spouse's record generally needs a marriage of at least 9 months and no remarriage before age 60 (50 with a disability).3

If this is you, your path looks like any other new enrollee's: you sign up for Part B (and usually a Part D drug plan), Part A comes premium-free, and the same enrollment windows and penalties apply. See how to sign up for Medicare and when to enroll.

Path 2: You have a green card but not enough work credits

This is where many immigrant families land, and it's the part most worth getting right. If you're a lawful permanent resident (a green card holder) who is 65 or older but you don't have 40 quarters of covered work, you can still get Medicare. There's one extra requirement, and it's a real one.

You must be a green card holder who has lived in the United States continuously for the 5 years immediately before the month you apply. This is often called the five-year rule, and it applies both to buying Part A and to enrolling in Part B when you're not entitled to premium-free Part A. Until you've met it, you can't yet enroll on this path, even at 65.1

Once you've cleared the five years, here's what you can do:

• Enroll in Part B (medical insurance) and pay the standard monthly premium.
• Buy Part A (hospital insurance) by paying a monthly Part A premium, if you want hospital coverage. Without the work record for premium-free Part A, Part A isn't free on this path, but you're allowed to purchase it. You have to sign up for Part B in order to buy Part A (before or at the same time), so this path means paying both premiums, not one, and the Part A application has to be filed during an enrollment period.1

When to file. Your Initial Enrollment Period is the 7 months around your 65th birthday: it starts three months before the month you turn 65 and ends three months after it. Outside that window, you can sign up for Part B and premium Part A only during another enrollment period, such as the General Enrollment Period, January 1 through March 31 each year, with coverage starting the month after you sign up.4 If you turn 65 before your five years are up, ask Social Security which enrollment period will apply once you meet the residence test, so you don't miss it.

Cuban or Haitian entrants and COFA residents. The buy-in rules for Part A and Part B name only citizens and green card holders who meet the 5-year residence test. If you're a Cuban or Haitian entrant or a COFA resident without enough work history for premium-free Part A, confirm your options with the Social Security Administration rather than assuming a buy-in is available.1

While you wait out the five years

Until you meet the residence test, the buy-in route is closed, so plan for the gap. Full Medicaid is usually not the fallback: green card holders generally face a separate five-year waiting period for Medicaid unless an exception applies.5 The exceptions include green card holders who are honorably discharged veterans meeting the minimum active-duty service requirement or who are on active duty (other than for training) in the armed forces, and a spouse, unmarried dependent child, or unremarried surviving spouse of someone who is.6 Emergency Medicaid, limited coverage for treating emergency medical conditions, remains available regardless of immigration status to people who meet Medicaid's other eligibility rules.5 For everyday care, HRSA's Find a Health Center tool locates federally funded health centers by city, state, or ZIP code.7

What Medicare costs for immigrants, and the penalty to avoid

Whichever path applies, you pay the Part B premium every month, even in a month you use no Part B services. Signing up late can cost you too: you might owe a Part B penalty for as long as you have Part B, a penalty on Part A if you're buying it and don't when you're first eligible, and a separate Part D penalty, which people who qualify for Extra Help don't pay.1

For 2026, the Centers for Medicare and Medicaid Services set the standard Part B premium at $202.90 a month, with a $283 annual deductible. People who must buy Part A pay $311 a month with 30 to 39 quarters of work, or $565 a month with fewer than 30 quarters. The spouse's record counts here too: CMS gives the reduced $311 rate to people who had at least 30 quarters of coverage or were married to someone with at least 30 quarters, so a short work record of your own does not automatically put you in the higher band.8

The late penalties work like this:

• Part B: if you skip it when first eligible and don't qualify for a Special Enrollment Period or a Medicare Savings Program, your premium rises 10% for every full 12-month period you could have had it, for as long as you have Part B.9
• Part A (only if you're buying it): if you delay, your Part A premium may go up 10%, and you pay that for twice the number of years you waited, though usually not if you qualify for a Special Enrollment Period.9
• Part D: if you skip it when you first get Medicare, or later go 63 days or more without creditable drug coverage, you add 1% of the national base premium for each full month without it, for as long as you have Part D. There's no Part D penalty if you qualify for Extra Help.9

If you or your spouse are still working and you're covered by a group health plan based on that current employment, you can sign up for Part B later during a Special Enrollment Period without a penalty. COBRA and retiree coverage don't count as coverage from current employment, so ask your plan whether your coverage qualifies before you rely on it.4

Which immigrants can no longer get Medicare

This is a hard part to read if it touches your family, and you deserve a clear answer rather than a vague one.

Undocumented immigrants are not eligible to enroll in Medicare, because Medicare is limited to the four categories above.1 That doesn't mean a family in this situation has no options for care. Emergency Medicaid covers the treatment of emergency medical conditions regardless of immigration status for people who meet Medicaid's other eligibility rules,5 and HRSA's Find a Health Center tool locates federally funded health centers near you.7

Some lawfully present immigrants lost eligibility in 2025. The same 2025 law that set the four categories above also removed Medicare eligibility from lawfully present people who fall outside them, including many refugees, asylees, and holders of Temporary Protected Status (TPS) and certain humanitarian or work-visa statuses. People in those categories can no longer newly enroll. Those who were already enrolled as of July 4, 2025 lose their Medicare entitlement 18 months later, on January 4, 2027, after a Social Security Administration review and a notice to each person affected. The law tests the status a person holds, so someone who later becomes a permanent resident falls inside it, but it sets out no procedure for getting coverage back after it ends.1

Where people losing Medicare can turn. Full Medicaid is not an automatic backstop for this group either. From October 1, 2026, federal funding for full Medicaid is limited to the same four categories, so refugees, asylees, parolees and others outside them lose full federal Medicaid unless they have another qualifying status, such as having already adjusted to permanent residence. Emergency Medicaid is unchanged, and a state may choose to keep covering these groups with its own funds.5 HRSA's Find a Health Center tool can point you to a federally funded health center nearby.7

If you think this may affect you or a parent, don't guess from a headline. Confirm your specific category with the Social Security Administration before assuming coverage is ending, and ask an immigration attorney whether a path to a still-eligible category (such as adjusting to permanent resident status) is open.

How to apply and confirm your status

Plenty of families genuinely don't know which category they fall into, especially when status has changed over the years or a spouse's work record is involved. That uncertainty is normal, and it's exactly the kind of thing you shouldn't guess at. These steps get you a firm answer.

1. Contact Social Security. The Social Security Administration handles Medicare enrollment, and it's the agency to ask about your status, category, and work credits.1 Call 1-800-772-1213 (TTY 1-800-325-0778), 8 a.m. to 7 p.m. local time, Monday through Friday. SSA provides free interpreter services by phone or in a Social Security office.10 You can also sign up online at ssa.gov/medicare/sign-up with a my Social Security account, or at a local Social Security office.11
2. Know your enrollment window. The dates are under "When to file" above; if you're not sure which window applies to you, ask Social Security when you call.
3. Get free, unbiased counseling. Your State Health Insurance Assistance Program (SHIP) gives free, personalized counseling to people with Medicare and their families, and can help you apply for programs that lower Medicare costs.12 Find yours at shiphelp.org or by calling 1-877-839-2675; your state's SHIP may go by a different name.13

Learn More

Find personalized help understanding your Medicare eligibility at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.