Do Immigrants Qualify for Medicare After the New Law?

Immigrants can qualify for Medicare, but only if they hold one of three immigration statuses and meet the same age or disability rules that apply to U.S. citizens. A federal law signed in July 2025 narrowed the list to lawful permanent residents (green card holders), certain Cuban and Haitian entrants, and citizens of Compact of Free Association nations lawfully residing in the United States.¹ Green card holders without enough work credits must also have lived in the U.S. continuously for at least five years before they can enroll.²

Who Qualifies Under the 2025 Law

The One Big Beautiful Bill Act, signed in July 2025, cut the list of eligible noncitizens down to three groups:¹

Lawful permanent residents (green card holders)
Certain Cuban and Haitian entrants who meet specific immigration criteria
Citizens of Compact of Free Association (COFA) countries — the Marshall Islands, the Federated States of Micronesia, and Palau — lawfully residing in the U.S.

Falling into one of those categories is necessary but not sufficient. You still have to satisfy the standard Medicare rules: age 65, or younger with 24 months of Social Security disability benefits, or a diagnosis of ALS or End-Stage Renal Disease.³

Who No Longer Qualifies

Before the 2025 law, a much broader range of lawfully present immigrants could enroll if they met the age and work-credit rules. That is no longer the case. If you hold one of the following statuses and do not also have a green card, you cannot enroll in Medicare, even if you have paid Medicare payroll taxes for years:¹

Refugees and asylees who have not adjusted status to lawful permanent resident
Temporary Protected Status (TPS) holders
Work visa holders, including H-1B and L-1
Humanitarian parolees
Undocumented individuals, who were never eligible

Someone who worked on an H-1B for a decade and paid into Medicare the whole time still cannot enroll. For refugees and asylees, adjusting to lawful permanent resident status is now the only path in, and the five-year residency clock for buying Part A runs from the original date of arrival in the U.S., not the date the green card is issued.

Green Card Holders: Two Paths In

Lawful permanent residents are the largest group of eligible noncitizens. Which path you take depends on your work history.

With 40 Quarters of Work Credits

If you or your spouse have earned at least 40 quarters (about 10 years) of Medicare-covered employment, you qualify for premium-free Part A the same way a U.S. citizen does. The quarters don’t have to be consecutive. The five-year residency rule does not apply on this path, because your eligibility flows from the Social Security work record.²

Spousal work records also count. If you are currently married, your spouse must be eligible for Social Security benefits and you must have been married at least one year. If divorced, the former spouse must be eligible for Social Security, the marriage must have lasted at least 10 years, and you must be currently single. If widowed, the marriage must have lasted at least nine months before your spouse’s death, and you must be currently single.

Without 40 Quarters of Work Credits

Green card holders who don’t have enough work credits can still buy into Medicare Part A, but only after living continuously in the United States for at least five years before the month of enrollment.² The clock starts when you arrived in the U.S. with the intent to establish a home, not when your green card was issued. Trips abroad of six months or less generally don’t break continuity.

Once you reach the five-year threshold and are 65 or older, you can purchase Part A and enroll in Part B. Because Part A carries a substantial monthly premium on this path, it is significantly more expensive than qualifying through work credits.

If You Already Have Medicare but Fall Outside the New Categories

Existing beneficiaries who don’t fit the three eligible groups face termination. The Commissioner of Social Security has to identify affected individuals within six months of the law’s enactment and notify them that enrollment will end one year after enactment, which puts the cutoff in mid-2026.¹ If you receive a termination notice, look at Marketplace coverage through HealthCare.gov before your Medicare ends.

Documentation You’ll Need to Enroll

When you apply through Social Security, you have to prove both identity and immigration status. SSA accepts several documents as evidence of lawful permanent resident status:⁴

Permanent Resident Card (Form I-551). If expired, SSA will accept it alongside a Form I-797 from USCIS showing the status has been extended.
Machine Readable Immigrant Visa with a temporary I-551 stamp or notation.
Temporary I-551 stamp placed in your passport by USCIS or a port of entry.
Alien Registration Receipt Card (Form I-151), the older version of the green card.

A USCIS receipt notice (Form I-797) on its own is not accepted. If your card was lost or stolen, get a replacement from USCIS before applying.⁴

How and When to Enroll

Medicare enrollment goes through the Social Security Administration. You can apply online at ssa.gov, call 1-800-772-1213, or visit a local Social Security office.⁵

Your Initial Enrollment Period is a seven-month window: the three months before your 65th birthday month, the birthday month itself, and the three months after.⁶ Signing up in this window avoids late penalties and gets you the earliest possible coverage start date.

If you miss it and don’t qualify for a Special Enrollment Period, you have to wait for the General Enrollment Period, which runs January 1 through March 31 each year. Coverage doesn’t begin until the month after enrollment, and delayed enrollment usually triggers a Part B premium surcharge of 10% for each full year you could have signed up but didn’t. That surcharge lasts as long as you have Part B.⁷

What Medicare Costs in 2026

Eligible immigrants pay the same premiums and deductibles as U.S. citizens. The main variable is whether you get Part A premium-free or have to buy it.

Part A is free with 40 quarters of work credits. With 30 to 39 quarters, the reduced 2026 premium is $311 per month. With fewer than 30 quarters, the full premium is $565 per month. The Part A inpatient hospital deductible is $1,736 per benefit period in 2026.⁸

The standard Part B premium is $202.90 per month in 2026.⁹ Higher earners pay more through the Income-Related Monthly Adjustment Amount, which Medicare calculates from your tax return two years back. The 2026 thresholds start at $109,000 for individual filers and $218,000 for joint filers, and the top Part B premium reaches $649.20.¹⁰

The national base beneficiary premium for Part D is $38.99 in 2026, with actual premiums varying by plan.¹⁰ Part D has its own income-based surcharges at the same income brackets as Part B.

Low-income beneficiaries may qualify for state-run Medicare Savings Programs or the federal Extra Help program, which reduces Part D costs. In 2026, Extra Help income limits are $23,940 for an individual and $32,460 for a married couple, with resource limits of $18,090 and $36,100.¹¹

Coverage During the Five-Year Wait

Green card holders who need to wait five years before buying into Medicare have a real coverage gap to fill. The most widely available option is the Health Insurance Marketplace at HealthCare.gov. Lawful permanent residents can buy Marketplace plans regardless of how long they’ve been in the country, and they may qualify for premium tax credits and cost-sharing reductions if household income falls between 100% and 400% of the federal poverty level.¹² Some states also offer Medicaid to lawful permanent residents during the five-year wait, though rules vary by state.

If you’re approaching 65 and won’t hit the five-year mark in time, don’t let your Marketplace or employer plan lapse before Medicare takes over. The gap between other coverage ending and Medicare starting is where late enrollment penalties and medical debt tend to hit hardest.

1
Congress.gov. Health Coverage Provisions in One Big Beautiful Bill Act (H.R. 1)
2
Centers for Medicare & Medicaid Services. Original Medicare Part A and B Eligibility and Enrollment
3
Centers for Medicare & Medicaid Services. Get Started with Medicare
4
Social Security Administration. Evidence of Lawful Permanent Resident (LPR) Status for an SSN Card (RM 10211.025)
5
Social Security Administration. Sign Up for Medicare
6
Medicare.gov. When Does Medicare Coverage Start
7
Medicare.gov. Avoid Late Enrollment Penalties
8
Centers for Medicare & Medicaid Services. 2026 Medicare Parts A and B Premiums and Deductibles
9
Medicare. Costs
10
Medicare.gov. 2026 Medicare Costs
11
Medicare. Help With Drug Costs
12
HealthCare.gov. Coverage for Lawfully Present Immigrants