Medicare Eligibility for Green Card Holders
For lawful permanent residents (LPRs), also known as green card holders, qualifying for Medicare involves a combination of legal status, residency duration, and work history. Unlike U.S. citizens who may have immediate access based on age or disability, most green card holders must meet a continuous residency requirement. This distinction is crucial for recent immigrants trying to navigate the complexities of the U.S. healthcare system.
Requirements for Lawful Permanent Residents
To be eligible for Medicare, a green card holder must first be lawfully admitted for permanent residence and have resided in the U.S. for five continuous years immediately prior to applying for Medicare Part A and B. The five-year period begins when an individual is formally admitted as a permanent resident.
Beyond the residency requirement, other factors include:
- Age: Generally, a green card holder must be 65 or older to qualify. However, individuals under 65 can qualify if they have received Social Security Disability Insurance (SSDI) benefits for at least 24 months or have End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS).
- Work Credits: To receive premium-free Medicare Part A (hospital insurance), a green card holder (or their spouse) must have worked and paid Medicare taxes for at least 40 quarters, or about 10 years. The work credits do not need to be earned consecutively. Individuals with fewer than 40 work credits may still be eligible for Medicare Part A but will need to pay a monthly premium.
What if I Don't Have Enough Work Credits?
If a permanent resident lacks the 40 required work credits, they can still access Medicare Parts A and B by paying premiums. For Part A, this premium can be substantial, depending on their work history. The Part B premium is a monthly cost for all beneficiaries, and a late enrollment penalty may be added if enrollment is delayed. It's also possible to enroll only in Part B and forego premium Part A coverage, but this leaves a significant gap in hospital coverage.
Special Eligibility for Spouses
An LPR who is married to a U.S. citizen or to another LPR with sufficient work credits can qualify for premium-free Medicare Part A based on their spouse's work record. The LPR spouse must have been married for at least one year and the qualifying spouse must be at least 62 years old. This provision eliminates the need for the LPR to meet the 10-year work requirement on their own, though they will still be subject to the five-year continuous residency rule for Part A and B enrollment.
Comparison of Medicare Eligibility for Immigrants
| Eligibility Factor | Lawful Permanent Resident (Green Card Holder) | Other Lawfully Present Immigrants | U.S. Citizen |
|---|---|---|---|
| Continuous Residency | Must have 5 years continuous residency immediately prior to applying for Part B, and for premium Part A if lacking work credits. | Previously eligible based on work history, but eligibility ended July 4, 2025, under new legislation. | No residency requirement. |
| Work Credits | Requires 40 work credits (10 years) for premium-free Part A. Can pay premium if credits are insufficient. | Previously required 40 work credits for premium-free Part A, but this pathway is no longer available to many lawfully present immigrants. | Requires 40 work credits (10 years) for premium-free Part A. Can also pay premium if credits are insufficient. |
| Age Requirement (standard) | Must be 65 or older. | Not applicable under new restrictions effective July 2025, unless a green card holder. | Must be 65 or older. |
| Disability Qualification | Eligible if under 65 and receiving SSDI for 24 months, with same LPR residency and work credit rules. | Eligibility for many lawfully present immigrants was terminated as of July 2025. | Eligible if under 65 and receiving SSDI for 24 months. |
| Eligibility under Spousal Record | Eligible if married to a qualifying U.S. citizen or LPR for at least one year. | N/A under new rules for many categories. | Eligible if married to a qualifying spouse for at least one year. |
Enrollment Process and Costs
For eligible green card holders, the enrollment process is managed through the Social Security Administration (SSA). It is important to apply during the appropriate enrollment period to avoid late enrollment penalties. The Initial Enrollment Period (IEP) typically begins three months before an individual's 65th birthday, includes their birthday month, and continues for three months after.
To enroll, green card holders will need to provide documentation to prove their permanent resident status and work history. The SSA will then process the application and determine eligibility for premium-free Part A based on work credits. Regardless of Part A status, a premium is required for Part B coverage.
For those who don't have enough U.S. work history for premium-free Part A, the costs can be significant. In 2025, the monthly premium for Part A for those with less than 30 work credits was substantial, while those with 30-39 credits paid a lower premium. In contrast, premium-free Part A is automatic for most U.S. citizens who have worked for 10 years or more. It is crucial for green card holders to understand these cost differences and plan for healthcare expenses in their retirement years.
What About the Recent Changes in Medicare Law?
Recent legislation, specifically H.R. 1 enacted on July 4, 2025, has significantly changed Medicare eligibility for certain immigrant groups. The law restricts Medicare access to a more limited set of lawfully present immigrants, primarily U.S. citizens, green card holders, certain Cuban/Haitian entrants, and individuals under the Compacts of Free Association. This means that immigrants previously eligible through work history, such as those with Temporary Protected Status or asylees, may lose their coverage by January 2027. Green card holders meeting the five-year continuous residency requirement and other criteria are not affected by this change.
Conclusion
Qualifying for Medicare as a green card holder depends on meeting specific criteria beyond simply holding permanent resident status. The five-year continuous residency rule is a foundational requirement for all LPRs seeking Medicare coverage. While premium-free Part A is possible with enough U.S. work credits, those with fewer credits will face significant premiums. Spousal work history can offer a pathway to premium-free Part A for some. Given recent legislative changes affecting other immigrant groups, it is more important than ever for green card holders and their families to understand the specific rules that apply to their situation and to enroll during the correct periods to avoid penalties. Consulting with the Social Security Administration directly or seeking advice from a licensed insurance agent is recommended to navigate the process effectively.
A Note on Public Charge Rule
In 2022, the U.S. government announced that it would not consider the receipt of most government benefits, including Medicare, in "public charge" inadmissibility determinations. This means that applying for or receiving Medicare should not negatively impact a green card holder's future immigration applications. Learn more at the USCIS official website.
