A Common Question With an Encouraging Answer
Immigrants and green-card holders approaching 65 often assume Medicare isn't available to them, or aren't sure of the rules. The reality is more encouraging: many lawfully present immigrants can get Medicare, though the specifics depend on your work history and how long you've been a permanent resident. Understanding your path helps you enroll on time and avoid both coverage gaps and unnecessary penalties.
The rules involve a few moving parts — citizenship or lawful residency status, work history (yours or a spouse's), and length of U.S. residency. Here's how they fit together.
The Two Ways to Qualify
For most people, Medicare eligibility at 65 comes down to two paths:
- Premium-free Part A through work: if you (or your spouse) worked and paid Medicare taxes in the U.S. for at least 10 years (40 quarters), you qualify for premium-free Part A — the same as any citizen
- Buying into Medicare: lawful permanent residents (green-card holders) who don't have enough work history can still get Medicare if they've lived in the U.S. as a permanent resident continuously for at least 5 years — but they pay a premium for Part A
- Part B is available to those eligible for Part A, with the standard premium
- U.S. citizens are eligible at 65 regardless, and naturalized citizens are treated the same as any citizen
What It Costs
The cost difference comes down to work history. If you or your spouse earned 40 quarters of Medicare-covered work, Part A is premium-free — you're in the same position as anyone else. If you don't have that work history but qualify by the 5-year residency route, you pay a monthly premium for Part A, and the amount depends on how many quarters of work you do have (partial work history reduces the premium).
Everyone pays the standard Part B premium ($202.90 for most in 2026), and higher earners pay IRMAA surcharges. Part D and any supplement or Advantage plan work the same as for anyone else. The residency and work-history rules affect Part A's premium, not the rest of the program.
Enrolling Correctly
The enrollment mechanics are the same as for anyone: you have an Initial Enrollment Period around your 65th birthday, and the same penalty risks for late enrollment apply. If you're still working with employer coverage, the same delay rules may let you postpone Part B. The key is confirming your eligibility path and premium before your window so you enroll correctly.
Immigration status and Medicare eligibility can involve details worth getting right — the difference between premium-free and premium Part A, the 5-year residency requirement, and how a spouse's work history counts. We help lawfully present immigrants and green-card holders in Wyoming and Utah understand their eligibility and enroll correctly, at no cost. If you're approaching 65 and unsure whether or how you qualify, that's exactly the kind of question we're glad to answer clearly.
Frequently Asked Questions
Can green-card holders get Medicare?
Yes. Green-card holders who worked (or whose spouse worked) 40 quarters in the U.S. get premium-free Part A. Those without that work history can still get Medicare if they've been a lawful permanent resident continuously for at least 5 years, but they pay a Part A premium.
Do immigrants pay more for Medicare?
Only for Part A, and only if they lack the 40 quarters of Medicare-covered work that make Part A premium-free. Part B, Part D, and supplements cost the same for everyone. Partial work history reduces the Part A premium.
How long must I be a permanent resident to get Medicare?
If you don't qualify through work history, you generally need to have been a lawful permanent resident (green-card holder) living continuously in the U.S. for at least 5 years to buy into Medicare.
Do naturalized citizens qualify for Medicare?
Yes, on the same terms as any U.S. citizen. Naturalized citizens are eligible at 65, with premium-free Part A if they or their spouse have 40 quarters of Medicare-covered work, just like anyone else.
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