Quick Answer
Green card holders (lawful permanent residents) can enroll in Medicare if they are 65 or older and have lived in the U.S. for at least 5 continuous years. Those with 40+ quarters of work history get premium-free Part A; others can purchase Part A at a monthly premium.
Coverage Comparison by Plan Type
| Plan Type | Coverage | Notes |
|---|---|---|
| Green Card + 40 Quarters (10 years work) | Premium-free Part A + standard Part B enrollment | Same eligibility as U.S. citizens; must meet 5-year residency |
| Green Card + 30-39 Quarters | Reduced Part A premium ($311/month in 2026) | Must also enroll in Part B and pay Part B premium |
| Green Card + Under 30 Quarters | Full Part A premium ($565/month in 2026) | Must also enroll in Part B; may want to consider alternatives |
| New Green Card (Under 5 Years Residency) | Not yet eligible for Medicare | Must wait until 5 continuous years of U.S. residency |
Understanding Your Coverage Options
Eligibility Requirements
To qualify for Medicare as a green card holder, you must be a lawful permanent resident (LPR) of the United States. You must be at least 65 years old and have lived continuously in the U.S. for at least 5 years immediately before applying.
Under the 2025 law changes (H.R. 1), Medicare eligibility is now restricted to U.S. citizens, green card holders, Cuban-Haitian entrants, and people residing under the Compacts of Free Association. Green card holders remain fully eligible.
What It Covers
- Lawful permanent residents (green card holders) age 65+
- Must have 5 continuous years of U.S. residency
- Cuban-Haitian entrants remain eligible
- Compacts of Free Association (COFA) residents remain eligible
What It Doesn't Cover
- Undocumented immigrants
- Visa holders (tourist, student, work visas)
- Refugees and asylees who haven't obtained green cards (after Jan 2027)
- People with Temporary Protected Status (TPS) after Jan 2027
2025 Law Change
Starting July 2025, only U.S. citizens, green card holders, Cuban-Haitian entrants, and COFA residents are eligible for Medicare. Other lawfully present immigrants will lose eligibility by January 2027.
The 5-Year Residency Requirement
The 5-year continuous residency rule requires that you have lived in the United States as a lawful permanent resident for at least 5 years immediately prior to enrolling in Medicare.
This means if you received your green card at age 62, you would need to wait until age 67 to enroll in Medicare. The 5 years must be continuous — extended trips abroad may reset the clock.
What It Covers
- Clock starts from the date your green card is issued
- Short trips abroad (under 6 months) generally don't break continuity
- Applies to both Part A and Part B enrollment
What It Doesn't Cover
- Time spent in the U.S. on a visa before getting green card doesn't count
- Absences over 12 months typically reset the 5-year clock
- Conditional residency may not count toward the 5 years
Late Enrollment Penalty
If you don't enroll during your Initial Enrollment Period (which starts 3 months before you meet all eligibility criteria), you may face a Part B late enrollment penalty of 10% for each 12-month period you were eligible but didn't enroll.
Premium-Free vs. Premium Part A
Whether you pay a premium for Part A depends on how many quarters (3-month periods) you or your spouse worked in the U.S. and paid Medicare payroll taxes.
With 40 or more quarters (10 years), you qualify for premium-free Part A. With 30-39 quarters, you pay a reduced premium. With fewer than 30 quarters, you pay the full premium.
What It Covers
- 40+ quarters: $0/month (premium-free Part A)
- 30-39 quarters: $311/month (2026 reduced premium)
- Under 30 quarters: $565/month (2026 full premium)
- Spouse's work history counts toward your quarters
What It Doesn't Cover
- Work performed outside the U.S. doesn't count toward quarters
- Self-employment without paying Medicare taxes doesn't count
- Under-the-table or cash work doesn't generate quarters
Part B, Part D, and Supplemental Coverage
Once eligible for Medicare, green card holders have access to all the same plan options as U.S. citizens. This includes Part B (medical insurance), Part D (prescription drugs), Medicare Advantage, and Medigap supplemental plans.
Part B costs $185/month in 2025 (standard premium) regardless of work history. You can also enroll in Medicare Advantage or Medigap plans during your initial enrollment period without medical underwriting.
What It Covers
- Part B: $185/month standard premium (2025), covers outpatient care
- Part D: Prescription drug coverage through private plans
- Medicare Advantage: All-in-one alternative to Original Medicare
- Medigap: Supplemental insurance to cover out-of-pocket costs
What It Doesn't Cover
- Part B doesn't cover long-term care or most dental/vision
- Medigap plans don't cover prescription drugs
- Coverage outside the U.S. is very limited
Alternatives While Waiting for Medicare
If you're a green card holder who hasn't yet met the 5-year residency requirement, you still have health insurance options available.
You may qualify for coverage through the Health Insurance Marketplace (HealthCare.gov), Medicaid (in some states after 5 years), or private health insurance plans.
What It Covers
- ACA Marketplace plans (may qualify for subsidies based on income)
- Employer-sponsored health insurance
- Medicaid (varies by state; some have 5-year waiting period)
- Private health insurance or short-term plans
What It Doesn't Cover
- Marketplace plans don't provide Medicare-equivalent coverage
- Short-term plans have limited benefits and exclusions
- Medicaid eligibility varies significantly by state
Medicare Costs for Green Card Holders (2025-2026)
| Coverage | Monthly Cost | Who Pays This |
|---|---|---|
| Part A (40+ quarters) | $0 | Green card holders with 10+ years of U.S. work history |
| Part A (30-39 quarters) | $311 (2026) | Green card holders with 7.5-10 years of work |
| Part A (under 30 quarters) | $565 (2026) | Green card holders with less than 7.5 years of work |
| Part B (standard) | $185 (2025) | All Medicare enrollees regardless of work history |
| Part D (drug plan) | $0-$100+ (varies) | Optional; varies by plan chosen |
| Medigap Plan G | $100-$300+ (varies) | Optional supplemental coverage |
✦ Important Exceptions & Special Situations
Spouse's Work History Counts
If your spouse (current or former, if married 10+ years) has 40 quarters of U.S. work history, you can qualify for premium-free Part A based on their record — even if you never worked in the U.S.
This is one of the most common paths to premium-free Part A for green card holders.
Disability-Based Medicare
Green card holders under 65 may qualify for Medicare through Social Security Disability Insurance (SSDI) after receiving disability benefits for 24 months. The same work credit requirements apply as for U.S. citizens.
End-Stage Renal Disease (ESRD)
Green card holders with ESRD (permanent kidney failure requiring dialysis or transplant) may qualify for Medicare regardless of age, provided they meet the work history or family member requirements.
Totalization Agreements
The U.S. has Social Security agreements with over 25 countries. Work credits earned in those countries may count toward the 40-quarter requirement for premium-free Part A.
Check if your home country has a totalization agreement with the U.S.
✦ 2025 Legislative Changes (H.R. 1)
Medicare Eligibility Restricted to Citizens & Green Card Holders
PassedStarting July 2025, only U.S. citizens, lawful permanent residents (green card holders), Cuban-Haitian entrants, and COFA residents are eligible for Medicare. Refugees, asylees, and TPS holders who haven't obtained green cards will lose eligibility by January 2027.
Green Card Holders Remain Fully Eligible
PassedThe new law explicitly preserves Medicare eligibility for lawful permanent residents (green card holders) who meet the existing 5-year residency and age/disability requirements.
Transition Period for Current Enrollees
PassedImmigrants who currently have Medicare but don't meet the new criteria will have their coverage terminated no later than January 2027, giving them time to find alternative coverage.
Steps to Enroll in Medicare as a Green Card Holder
If you're a green card holder approaching Medicare eligibility, planning ahead can help you avoid penalties and gaps in coverage.
Enrollment Checklist
- Confirm you've had your green card for at least 5 continuous years
- Check your work history (or spouse's) at ssa.gov for quarter count
- Identify your Initial Enrollment Period (3 months before to 3 months after your 65th birthday)
- Decide between Original Medicare + Medigap or Medicare Advantage
- Enroll in Part B during your IEP to avoid late enrollment penalties
- Consider Part D prescription drug coverage to avoid that late penalty too
- If you must buy Part A, budget for both Part A and Part B premiums
✦ Frequently Asked Questions
David Haass
AuthorDavid Haass is a licensed insurance agent and Medicare specialist at MedicareFAQ.com.
Ashlee Zareczny
ReviewerAshlee Zareczny is the Compliance & Editorial Manager at MedicareFAQ.