If you came to this country later in life, or you're helping a parent who did, you may assume Medicare is off the table. For most lawful permanent residents, it isn't. Whether an immigrant qualifies for Medicare comes down to two things: whether enough Medicare taxes were paid through work, and how long the person has held a green card. This guide walks each path in plain language, so you can see where your family fits.

You're not alone in this question

Sorting out a benefit you've never had access to before, in a language of acronyms and fine print, is genuinely hard. It's harder still when the stakes are a parent's health coverage and you're not sure whether asking the wrong agency the wrong question could cause a problem. Take a breath. The rules here are knowable, and immigration status by itself doesn't shut the door the way many people fear it does.

Two things decide whether a green card holder qualifies for Medicare: whether enough Medicare taxes were paid through work, and how long the person has been a lawful permanent resident. But there's a newer piece families need to know about first. A 2025 federal law narrowed which immigration categories can be in Medicare at all, and it matters before you look at work history or residence. Everything below comes from the Centers for Medicare and Medicaid Services (CMS), the agency that runs the program, and from the federal statute itself.

Which immigrants Medicare covers: the four lawful categories

Before work history or residence enters the picture, Medicare asks a threshold question: what is your immigration category? As of a 2025 law, only four categories of people can be entitled to or enrolled in Medicare. Under section 71201 of the One Big Beautiful Bill Act (Public Law 119-21, enacted July 4, 2025), which added section 1899C to the Social Security Act, an individual may be in Medicare only if they are:

  • 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.

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. What changed in 2025 is the outer boundary: lawfully present immigrants who fall outside these four categories are covered under "Who 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, you qualify for premium-free Part A on the same basis as a U.S. citizen.

A "quarter" is roughly three months of work where you paid Medicare payroll taxes. Forty quarters works out to about 10 years. Two details matter for families:

  • Those years don't all have to be recent or continuous. They add up over a working lifetime.
  • You can 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.

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 have been lawfully admitted for permanent residence and have resided in the United States continuously for the 5 years immediately before 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.

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. Because you don't have the 40 quarters, Part A isn't free on this path, but you're allowed to purchase it.

So the honest picture is this: a green card holder without the work history isn't getting Medicare for free, but the door is open after five years of residence, and the coverage is real once you walk through it.

What Medicare costs for immigrants, and the penalty to avoid

Whichever path applies, Part B and Part D come with monthly premiums, and both carry a late-enrollment penalty if you don't sign up when you're first eligible. This is the trap to watch, because the Part B penalty in particular can follow you for life.

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.

Your situation Part A Part B Late-penalty risk
65+, green card, 40 quarters of work (yours or spouse's) Premium-free $202.90/mo standard Yes, if you delay Part B or D without other coverage
65+, green card, 5 continuous years, fewer credits Buy it: $311 or $565/mo $202.90/mo standard Yes, same penalties apply
Not in an eligible category (or undocumented) Generally not eligible to enroll Not eligible N/A

The penalties are worth stating plainly. If you skip Part B when first eligible and don't have other creditable coverage, your premium rises 10% for every full 12-month period you could have had it, for as long as you have Part B. Part D adds 1% of the national base premium for each month you went without creditable drug coverage. The lesson: enroll during your window unless you have qualifying coverage from a current job.

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 generally not eligible to enroll in Medicare. Lawful presence is the threshold the program runs on. That doesn't mean a family in this situation has no options for care at all: community health centers, local programs, and emergency Medicaid for qualifying emergencies are separate systems with their own rules, and they're worth looking into rather than assuming nothing exists.

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 lose their Medicare entitlement 18 months after the law took effect, by January 4, 2027, after the Social Security Administration reviews cases and sends notice.

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.

If you're not sure which category you're in

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.

The Social Security Administration handles Medicare enrollment and can confirm your work credits, your years of residence, and whether you meet Medicare's eligibility category, which since the 2025 law is limited to citizens and nationals, green card holders, Cuban or Haitian entrants, and COFA residents. Contacting them to ask is not a risk to your status; it's the agency's job to sort this out. If your situation is complicated, an immigration attorney or a benefits counselor can help you read it before you apply.

Social Security Administration (SSA) Confirms your Medicare work credits, checks your residency history, tells you which eligibility category you're in, and handles Medicare enrollment. 1-800-772-1213 ssa.gov

Frequently Asked Questions

Can a green card holder get Medicare at 65?

Yes, but how depends on work history. With 40 quarters of Medicare-covered work (yours or a spouse's), you get premium-free Part A like a citizen. Without those credits, you can enroll after living in the U.S. as a lawful permanent resident for 5 continuous years, taking Part B and buying Part A.

Does my spouse's work count toward Medicare?

Yes. You can qualify for premium-free Part A based on a current, former, or deceased spouse's 40 quarters of Medicare-covered work, even if you didn't work those years yourself.

What is the 5-year rule for Medicare?

A green card holder who lacks enough work credits must have been a lawful permanent resident and lived in the U.S. continuously for the 5 years right before applying. Only after meeting that residency test can they enroll in Part B and buy Part A.

Which immigrants are eligible for Medicare now?

As of a 2025 federal law, Medicare covers only four lawfully present categories: U.S. citizens and nationals, green card holders, Cuban or Haitian entrants, and people lawfully residing under a Compact of Free Association. Lawfully present immigrants outside these four (including many refugees, asylees, and TPS holders) can no longer newly enroll, and those already enrolled lose coverage after January 4, 2027.

Can undocumented immigrants get Medicare?

Generally no. Medicare enrollment requires lawful presence in an eligible category, so people who are not lawfully present are not eligible to enroll.

Who do I contact if I'm unsure about my eligibility?

Contact the Social Security Administration at 1-800-772-1213, which handles Medicare enrollment and can confirm your work credits, residency, and eligibility category. For complex immigration questions, a qualified immigration attorney or benefits counselor can help.

Learn More

MedicareWhat is Medicare? Parts A, B, C, and D explainedWhat is Medicare? A plain guide to Parts A, B, C, and D, who qualifies, 2026 costs, when to enroll, and what it doesn't cover, with help-paying options. MedicareHow to sign up for Medicare, step by stepHow to sign up for Medicare: find out if you're auto-enrolled, how to apply through SSA online, by phone, or in person, and what documents and choices you need. MedicareWhen to sign up for Medicare, and the late penaltiesWhen to sign up for Medicare without a lifelong penalty: the 7-month Initial Enrollment Period, working past 65, the GEP, and what each late penalty costs.

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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.

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Brevy Care Team

Expert eldercare guidance from Brevy's team of healthcare professionals and researchers.