Eligibility rules
Medicare as a green card holder: eligible, but not automatically free
Short answer: lawful permanent residents can get Medicare at 65, but whether it costs anything depends on work history. With 40 quarters of Medicare-covered work, roughly ten years, in the United States, Part A is free, through your own record or a spouse’s. Without that history, you can still buy Part A and Part B if you are 65 or older and have been a lawful permanent resident with five continuous years of residence. Buying in is expensive, up to $565 a month for Part A in 2026 plus the Part B premium, which makes the marketplace alternative worth pricing honestly before deciding.
Key takeaways
- Lawfully present immigrants aged 65+ can enroll in Medicare, but premium-free Part A requires 40 quarters of covered work.
- Without that work history, you can buy Part A if you have been a lawful permanent resident for five continuous years.
- Buying Part A costs $311 or $565 a month in 2026 depending on quarters worked, plus $202.90 for Part B.
- Credits from a spouse, including a deceased or former spouse in some cases, can qualify you for premium-free Part A.
- Late enrollment penalties apply here too, so the five-year mark is a date worth calendaring.
Who is eligible
| Your situation | Part A | Part B |
|---|---|---|
| 65+, lawfully present, 40 quarters of covered work (yours or a spouse’s) | Premium-free | Available at the standard premium |
| 65+, lawful permanent resident, 5 continuous years of residence, fewer than 40 quarters | Available to buy | Available at the standard premium |
| 65+, lawful permanent resident, less than 5 years of residence | Not yet available | Not yet available |
| Under 65 with a qualifying disability or ESRD, lawfully present | Same rules as other beneficiaries | Same rules as other beneficiaries |
Quarters of coverage are earned through work on which Medicare taxes were paid. Work in another country generally does not count, though some totalization agreements affect Social Security differently than Medicare.
What it costs to buy in
For 2026, the Part A premium is $311 a month with 30 to 39 quarters of covered work and $565 a month with fewer than 30 quarters. Part B is $202.90 at the standard rate on top of that. Buying both without any work history therefore runs close to $770 a month before any drug plan or supplement, which is a serious number and the reason this decision deserves arithmetic rather than assumption. Two things soften it: Medicare Savings Programs can pay the Part B premium and, in some tiers, the Part A premium too for people with limited income, and Extra Help covers drug costs. Eligibility for those programs is determined by your state, and immigration status rules for them differ from Medicare’s, so ask rather than assume.
The spouse route, which people overlook
You do not need 40 quarters of your own work. You can generally qualify for premium-free Part A on a spouse’s record if you are 65 and your spouse is at least 62 and has the required quarters. In certain circumstances the record of a deceased spouse or a former spouse from a marriage that lasted at least ten years can also qualify you. This turns an expensive problem into a free benefit for a lot of couples, and it is missed constantly because people assume eligibility follows only their own employment. The full spouse-record rules cover marriage, divorce, and widowhood.
If Medicare is too expensive right now
Two alternatives are worth pricing. Marketplace coverage remains available to lawfully present immigrants, and people who are lawfully present but ineligible for Medicaid because of the five-year bar can qualify for premium tax credits at income levels that would otherwise be too low. Note that the enhanced credits expired at the end of 2025, so the arithmetic changed; the bridge-coverage article covers the current landscape. Employer coverage, yours or a spouse’s, also remains an option, and working long enough to reach 40 quarters is sometimes the cheapest path of all, since each additional quarter moves you toward free Part A permanently.
Timing and penalties
The enrollment rules apply to you the same way they apply to everyone else, which means the penalties do too. If you become eligible at the five-year residency mark and delay Part B without other creditable coverage, the 10% per year permanent penalty accrues. Your enrollment window works the same way as anyone else’s, and coverage start dates follow the standard schedule. Practical advice: calendar the month you complete five years of permanent residence, and plan the enrollment conversation two or three months before it, with free bilingual help available through SHIP counselors and 1-800-MEDICARE, which offers interpretation services.
Questions people also ask
Can green card holders get Medicare?
How much does Medicare cost without enough work history?
Do I need 10 years of work to get Medicare?
What is the five-year rule for Medicare?
What are the alternatives if I cannot afford Medicare?
Sources for this article
- Medicare.govMedicare.gov: eligibility, Part A premiums, and enrollment requirements.
- SSA.govSigning up for Medicare: work credits, spouse records, and applying.
- CMS.gov2026 Medicare premiums and deductibles: the Part A buy-in and Part B premium amounts.
Figures checked against these sources on September 30, 2026. We update within days when CMS publishes new amounts.
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