Did you know that you don’t have to be a U.S. citizen to qualify for Medicare? Between the growing number of older immigrants in the U.S. and the unique hurdles they face enrolling in Medicare, Medicare and immigration is an important topic to discuss.

If you are not a U.S. citizen, but are lawfully present, you may be able to get Medicare coverage, depending on your situation. We will discuss two ways non-citizens can be eligible for Medicare:

Non-citizens who qualify for Federal Disability or Retirement benefits are eligible for Medicare. 

If you qualify for Social Security Retirement Benefits, Social Security Disability Insurance, or Railroad Retirement Benefits, you are eligible for Medicare. In other words, if you qualify for premium-free Part A, you are Medicare-eligible, regardless of your immigration status and residency.

• To be eligible for retirement benefits and premium-free Part A at age 65, you must have worked at least 40 calendar quarters, or ten years, in the U.S. and paid Social Security tax.
• To qualify for premium-free Part A before age 65, you must meet pro-rated work history requirements that are based on the age you became disabled and when the work was performed.
• If you don’t have enough work history, you may still be eligible based on your spouse’s work history.

If you aren’t sure how many quarters of work history you or your spouse has, you can contact the Social Security Administration (SSA) to ask. You can also make an online account at www.ssa.gov to check your number of work quarters online.

Non-citizens who have been permanent U.S. residents for five continuous years are also eligible for Medicare.

Legal permanent residents, or LPRs, are non-citizens who are allowed to live in the U.S. indefinitely. A person who has the immigration status of LPR is sometimes referred to as a “green card holder.”

If you are an LPR who doesn’t qualify for the federal benefits just described, you can be eligible for Medicare if you have lived in the U.S. continuously for five years before enrolling in Medicare. The five years begins the day you arrive in the U.S. with the intention of establishing a home, not just for a visit. You can keep your LPR status even if you leave the U.S. temporarily, meaning for no more than six months. These short visits out of the country shouldn’t be considered a break in your period of residence in the U.S. for the five-year residency requirement.

If you meet the residency requirement and qualify for Medicare, you still might not qualify for “premium-free Part A.” (Social Security sometimes refers to this as not being “entitled” to Part A.) Even if you don’t qualify for premium-free Part A, though, you can still purchase it for a monthly premium.

Even if you don’t qualify for Medicare, you may have other coverage options. 

• Marketplace coverage: Any lawfully present immigrant can get Marketplace coverage. There are no length of residency requirements for Marketplace coverage. Even if you do qualify for Medicare, but not for premium-free Part A, you may find it more affordable to enroll in a Marketplace plan rather than Medicare. To learn more about Marketplace coverage, go to HealthCare.gov or contact your state Marketplace if your state has one. However, if you’re eligible for Medicare but choose Marketplace coverage instead, you may face late enrollment penalties and gaps in coverage if you later decide you want to enroll in Medicare.
• Medicaid: Most non-citizens will have to meet a five-year residency requirement for Medicaid coverage, but not all. Each state’s eligibility for its Medicaid programs is different. For example, states can remove the length of residency requirement or LPR status for pregnant people and children, or provide additional coverage for people with any immigration status using state funding. Even if you aren’t lawfully present, including if you are undocumented, you can still get Medicaid coverage for emergency care. To learn more about your state’s Medicaid programs, contact your local Medicaid agency.

Still have questions?

Your SHIP is here for you! You can contact your SHIP for any Medicare-related questions or concerns you have. SHIP counselors are government funded to provide trusted, unbiased Medicare counseling at no cost to you. (Depending on your state, your SHIP may go by another name.) Use our online SHIP Locator or call 877-839-2675 (and say “Medicare” when prompted) to find your local SHIP.

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