Medicare and immigrants — who qualifies, and how green-card holders earn it

Medicare and immigrants

Medicare is the federal health-insurance program mainly for people 65 and older (and some younger people with certain disabilities). Whether an immigrant can get it — and whether it’s free — depends on immigration status and US work history. This page explains the rules clearly. Updated September 24, 2026 for the status limit that Public Law 119-21 added to Medicare.

This is general information, not legal, tax, or medical advice. Confirm your situation with the Social Security Administration or a benefits counselor.

Who is eligible

The 2025 law that limits Medicare by status (as of September 24, 2026)

Section 71201 of Public Law 119-21 (enacted July 4, 2025) added section 1899C to the Social Security Act (42 U.S.C. 1395mmm). Its core sentence says an individual “may be entitled to, or enrolled for, benefits under this title only if the individual is” —

1. “a citizen or national of the United States”;
2. “an alien who is lawfully admitted for permanent residence under the Immigration and Nationality Act”;
3. “an alien who has been granted the status of Cuban and Haitian entrant, as defined in section 501(e) of the Refugee Education Assistance Act of 1980”; or
4. “an individual who lawfully resides in the United States in accordance with a Compact of Free Association”.

People already on Medicare on July 4, 2025. Section 1899C(b) delays the limit for them: it applies “beginning on the date that is 18 months after such date of enactment” — January 4, 2027. The Commissioner of Social Security had to complete a review of those enrollees “not later than 1 year after the date of the enactment” (July 4, 2026) to identify people outside the four groups, and must notify each one that their entitlement or enrollment “will be terminated as of the date that is 18 months after the date of the enactment.”

Everyone else. Section 1899C sets a delayed start date only for people who were already entitled or enrolled on July 4, 2025.

This section describes the statute text. It does not describe how the Social Security Administration is carrying out the review or the notices; for an individual Medicare record, the source is the Social Security Administration.

The 40-quarters rule (premium-free Part A)

Medicare Part A (hospital insurance) is premium-free if you — or your spouse — worked and paid Medicare taxes for at least 40 quarters (about 10 years). Quarters are credited based on earnings, and they can come from work done while authorized.

• 40+ quarters: premium-free Part A at 65, if you are in one of the status groups Medicare is limited to (above).
• Fewer than 40 quarters: you can still get Part A by paying a monthly premium, if you meet the status/residency rules below.

How green-card holders qualify or buy in

If you are a lawful permanent resident, are 65 or older, and have lived in the US continuously for the 5 years immediately before the month you apply, you can enroll in Medicare. If you don’t have 40 quarters, you pay a monthly Part A premium (plus the standard Part B premium). Many LPRs enroll during their Initial Enrollment Period around their 65th birthday — missing it can mean late-enrollment penalties, so plan ahead.

This is the usual situation for green-card holders who immigrated later in life — including parents sponsored by their US-citizen children. They often reach 65 without 40 US work quarters, so they must both wait out the 5-year residency clock and pay the buy-in premium below.

What Medicare costs in 2026

If you qualify by residency but lack the 40 quarters, you buy in to Part A. The monthly Part A premium for 2026 depends on how many Medicare work quarters you (or your spouse) have:

Everyone enrolled in Medicare also pays Part B (doctor and outpatient care): the standard 2026 premium is $202.90 per month, with a $283 annual deductible. Part A’s inpatient hospital deductible is $1,736 per benefit period in 2026. Higher-income enrollees pay a surcharge on Parts B and D (the income-related monthly adjustment amount, or IRMAA).

Premiums and deductibles are 2026 figures from the CMS “2026 Medicare Parts A & B Premiums and Deductibles” fact sheet (see Official resources).

Why undocumented workers pay but can’t collect

Workers paid on a W-2 have 1.45% withheld for Medicare (matched by the employer); self-employed people pay it through self-employment tax. This happens regardless of immigration status. But the law ties receiving Medicare to status — since July 4, 2025, to the four groups in section 1899C — so many people, including lawfully present workers outside those groups, contribute to Medicare for years without being able to use it.

The parts of Medicare

• Part A — Hospital insurance: inpatient hospital, skilled nursing, hospice. Premium-free with 40 quarters.
• Part B — Medical insurance: doctor visits, outpatient care. Has a standard monthly premium.
• Part C — Medicare Advantage: private plans that bundle A, B, and usually D.
• Part D — Prescription drugs: optional drug coverage through private plans.

If you’re not eligible for Medicare

• Emergency Medicaid covers emergencies (including childbirth) regardless of status.
• Community health centers provide primary care on a sliding scale to everyone — see community health centers.
• Depending on status and state, marketplace or state coverage may be available.
• See healthcare access rights for what you can use regardless of status.

Official resources

• Medicare.gov
• Social Security — Medicare
• CMS — 2026 Medicare Parts A & B premiums and deductibles
• Public Law 119-21 — section 71201 adds Social Security Act section 1899C

Last verified: 2026-09-24. General information, not legal, tax, or medical advice. Eligibility rules change — confirm with the Social Security Administration or a benefits counselor for your situation.

Related procedural information

• Medicaid by state — health coverage for low-income residents
• Community health centers — care regardless of status
• Healthcare access rights
• Cross-border tax & Social Security totalization