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Are People Living in the U.S. Who Aren’t Citizens Eligible for Medicare?

Most who legally work can qualify, but a law passed in July removes others from eligibility

7-minute read

Tony Pugh and Kimberly Lankford,

Updated October 01, 2025

AARP

En español

Published April 27, 2023

/ Updated October 01, 2025

Chris Gash

Key takeaways

Not all lawfully present noncitizens qualify for Medicare now.
Immigrants who qualify have the same requirements as citizens.
They’ll pay the same premiums and other fees as citizens.
More than a half-dozen classes of immigrants are excluded now.
Who is still eligible and how to get financial help for costs.

Yes. Immigrants, like U.S. citizens, can qualify for Medicare.

But for immigrants who aren’t citizens to be eligible, their immigration status in addition to their work history must meet the federal health program’s requirements. Those without legal status have never been eligible for Medicare benefits.

Until mid-2025, all lawfully present immigrant workers who have paid Medicare payroll taxes for at least 40 quarters, 10 years total, were eligible for Medicare premium-free Part A, which helps pay for inpatient hospital stays and some other expenses. That’s the same as U.S. citizens.

But the One Big Beautiful Bill Act (OBBBA), which became law in July, limited the classes of lawfully present immigrants who can qualify for Medicare coverage.

How can immigrants who are eligible qualify for coverage?

You or your spouse must have worked in the U.S. and paid Medicare payroll taxes for at least 10 years to be eligible for premium-free Part A coverage at age 65. Those who don’t qualify for premium-free Part A coverage may be eligible for the coverage by paying premiums, but only if they meet a five-year continuous residency requirement.

These are the rules for lawfully present immigrants who retain Medicare eligibility:

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If you or your spouse paid Medicare taxes for at least 40 calendar quarters, not necessarily continuously, but 10 years total, you can enroll in Medicare at age 65 and get premium-free Medicare Part A, which covers a variety of hospital costs. But that’s only if you’re a U.S. citizen or among the classes of eligible lawfully present immigrants under the new law.

Medicare-eligible “lawfully present individuals with the required work credits have no length-of-residency requirement,” says Tiffany Huyenh-Cho, director of California Medicare and Medicaid Advocacy for Justice in Aging. The national nonprofit advocates for older adults.

Married? Medicare-eligible lawfully present immigrants wed for at least one year can qualify for Medicare Part A with no premiums based on their spouse’s work history.

You can be older than the spouse whose work history is the qualifier. If you’re at least 65 years old with a spouse at least age 62 who has 40 quarters of work credits, you’ll qualify for premium-free Medicare Part A based on your spouse’s work history.

A lawfully present immigrant married at least a year to a spouse whose work history qualifies for Medicare is eligible for Medicare at age 65.

When the qualification for premium-free Part A is already met, “other factors, such as five years of residency, are not taken into consideration,” says Darren Lutz, a Social Security Administration spokesperson.

If neither you, a Medicare-eligible noncitizen with lawfully present immigration status, nor your spouse paid Medicare taxes for 10 years, you must meet the five-year continuous residency requirement.

If you’re a green card holder, also known as a lawful permanent resident — or in one of the other classes of Medicare-eligible noncitizens with lawfully present immigration status — but neither you nor your spouse meet the work requirements, you can enroll in Medicare only if you’ve lived continuously in the U.S. for at least five years and pay premiums for Part A and/or Part B doctor and outpatient services.

How much do eligible noncitizens pay for Medicare?

A Medicare-eligible, lawfully present immigrant with the work history and residency requirements can sign up for each part of Medicare that a citizen can and pay the same as a citizen who qualifies. Premiums for Medicare Advantage, Part D prescription drug plans and Medicare supplemental insurance always vary depending on the insurer and type of coverage, but the federal government sets rates for Parts A and B.

Part A for 2025

$518 a month, fewer than 30 quarters
$285 a month, 30 to 39 quarters
Free if you or your spouse has worked 40 quarters or more

Part B for 2025

$185 a month for most Medicare beneficiaries
$74 to $443.90 a month more for high earners

If you’re required to pay premiums for Part A — again, if you or your spouse hasn’t paid Medicare payroll taxes for at least 40 quarters — you must also enroll in Part B.

To save on premiums, you can choose to forgo the more expensive Part A coverage and sign up for only Part B. That means you’ll have Medicare coverage for doctor’s services, outpatient care and equipment but not for hospitalization or care at a skilled-nursing center.  

Like other Medicare beneficiaries, lawfully present immigrants eligible for Medicare can buy Part D prescription coverage if they have Part A or Part B or both. However, you must have Part A and Part B to buy a supplemental Medigap policy or join a Medicare Advantage plan, also known as Medicare Part C.

What noncitizens aren’t eligible for Medicare anymore?

Noncitizens considered ineligible for Medicare under the new law include:

Refugees who’ve resettled in the United States
Self-petitioners for lawful status under the Violence Against Women Act
Noncitizens with deferred action from deportation
Spouses or children of U.S. citizens with an approved visa petition who have a pending application for adjustment of status
Those granted asylum or “withholding of removal” protection from deportation because of possible persecution in their home country
People with temporary protected status, which is granted to migrants from some countries who are unable to live safely in their homeland

A Congressional Research Service report lists the classes of noncitizens previously considered to be lawfully present for Medicare purposes before passage of the OBBBA.

Some of the Medicare rules for noncitizens changed in mid-2025.

By July 2026, the new law directs the head of the Social Security Administration to identify newly ineligible immigrants already enrolled in Medicare and notify them that their coverage will be terminated in January 2027.

If you have questions about your eligibility, call 800-MEDICARE or contact your local State Health Insurance Assistance Program (SHIP).

What noncitizen groups remain eligible for Medicare?

Green card holders are among only three groups of lawfully present noncitizens that retain Medicare eligibility under the new law if they meet the program’s work history, disability and age requirements.

Noncitizens living in the U.S. under a Compact of Free Association (COFA) with the Marshall Islands, Micronesia and Palau, as well as certain immigrants from Cuba and Haiti, also continue to be eligible for Medicare.

Those same groups still can qualify for premium-free Medicare Part A coverage by virtue of their spouse’s work history. Individuals in these groups not eligible for premium-free Part A coverage can purchase it after five years of continuous legal residency in the U.S.

Keep in mind

Unlike previous years when all lawfully present immigrants who met Medicare’s work, disability and age requirements were eligible for program coverage, only certain groups of these noncitizens now qualify for Medicare because of the OBBBA.

Whether or not you pay Part A premiums, Medicare-eligible noncitizens may qualify for help with Medicare premiums and out-of-pocket costs from a Medicare Savings Program, says Diane Omdahl, author of Medicare for You: A Smart Person’s Guide. She also is cofounder and president of 65 Incorporated, a Mequon, Wisconsin, company that helps people with Medicare decisions.

Eligibility requirements vary by state but are typically based on income and, sometimes, assets. Some states have residency requirements, too. Contact your state Medicaid agency for more information.

Immigrants eligible for Medicare may also qualify 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 local State Health Insurance Assistance Program (SHIP).

This story, originally published April 28, 2023, has been updated to reflect changes from passage of the One Big Beautiful Bill Act.

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About the authors

Tony Pugh is an award-winning writer and editor covering Medicare for AARP. He has also covered Medicare for Bloomberg Law and as a national correspondent for Knight Ridder/McClatchy Newspapers.

Kimberly Lankford is a contributing writer who covers Medicare and personal finance. She wrote about insurance, Medicare, retirement and taxes for more than 20 years at Kiplinger’s Personal Finance and has written for The Washington Post and Boston Globe. She received the personal finance Best in Business award from the Society of American Business Editors and Writers and the New York State Society of CPAs’ excellence in financial journalism award for her guide to Medicare.