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Are people who are not U.S. citizens eligible for Medicare?

Yes. You don’t have to be a U.S. citizen to qualify for Medicare, but requirements hinge on whether you or your spouse worked in the United States and paid Medicare payroll taxes. If not, you’ll have to pay premiums for coverage.  

If you or your spouse paid Medicare taxes for at least 40 calendar quarters that don’t have to be consecutive, 10 years total, you can enroll in Medicare at age 65 and get premium-free Medicare Part A — but only if you’re considered “lawfully present.” In this case, the term designates a legal permanent resident, often called a green card holder, or someone who is legally in the United States.

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If neither you nor your spouse paid Medicare taxes for 10 years, you must meet additional requirements. If you’re a U.S. citizen, you can qualify for Medicare at 65 if you pay premiums for Part A and Part B.

If you’re a green card holder but don’t meet work requirements, you can buy into Medicare only if you’ve lived continuously in the United States for at least five years.  

How much do noncitizens pay for Medicare?

The charges are the same for citizens and noncitizens. If you or your spouse hasn’t paid Medicare payroll taxes for 10 years, the following premiums for Medicare Part A and Part B apply in 2023:  

Part A  

  • $506 a month, fewer than 30 quarters.
  • $278 a month, 30 to 39 quarters.
  • Free, if you or your spouse has worked 40 quarters or more.  

Part B

  • $164.90 a month, the same as for people who have paid Medicare payroll taxes for 10 years. 
  • $65.90 to $395.60 a month additional for high earners.

What parts of Medicare can noncitizens enroll in?  

Coverage for parts A, B, C and D are possible. Many of the same rules apply to U.S. citizens.  

Special enrollment rules kick in if you don’t qualify for premium-free Part A. If you’re required to pay premiums for Part A — you’re not eligible for free coverage because you or your spouse hasn’t paid Medicare payroll taxes for at least 40 quarters — you must also enroll in Part B.

You can choose to forgo the more expensive Part A coverage altogether and sign up just for Part B. That means you would have Medicare coverage for doctor’s services, outpatient care and equipment, but not for hospitalization or care at a skilled-nursing center.  

Whether you have to pay Part A premiums or not, you still can buy Medicare Part D prescription coverage if you have Part A or Part B or both. However, you must have Part A and Part B to buy a supplemental Medigap policy or a Medicare Advantage plan.

Keep in mind  

If you must pay Part A premiums, you potentially could get help with the costs from Medicaid or a Medicare Savings Program. Eligibility requirements vary by state, and some have residency requirements. Contact your state Medicaid agency for more information.  

You also may be eligible for help with Part D prescription costs through the Extra Help program. It doesn’t have the same residency requirements as Medicaid and Medicare Savings Programs. For more information, and to find Medicare help in your area, contact your State Health Insurance Assistance Program (SHIP).

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