Can Green Card Holders Get Medicare? The Rules at 65

Yes, green card holders can get Medicare at 65, but the route depends on work history. If you or your spouse paid Medicare taxes for about 10 years, you can usually get premium free Part A like a citizen. If not, you can buy Part A and Part B only after living in the US continuously for five years as a lawful permanent resident. In 2026, bought Part A costs $311 or $565 a month, according to Medicare.gov.

Key facts at a glance

• The residence rule: 42 CFR 406.20 lets a lawful permanent resident buy Part A after residing in the US continuously for the five years before meeting the other requirements; 42 CFR 407.10 applies a similar test to Part B.
• Premium free Part A: Medicare.gov says Part A costs $0 for most people because they or a spouse paid Medicare taxes long enough, generally at least 10 years.
• 2026 costs: CMS lists the Part B standard premium at $202.90 a month, the Part B deductible at $283, and the Part A hospital deductible at $1,736.
• Enrollment window: the Initial Enrollment Period lasts seven months, starting three months before the month you first become eligible.
• Late penalties: Medicare.gov says the Part B penalty is 10% for each full year you could have enrolled but did not, for as long as you have Part B.

What is the five year rule for Medicare?

Medicare law separates people who earned coverage through work from people who buy it. For those who buy it, the regulations require residence and status: you must live in the US and be either a citizen or a lawful permanent resident who has resided here continuously for the five years before enrolling. A green card on its own is not enough; the five years of continuous residence are what open the door.

Long periods abroad can raise questions about whether residence was continuous. Keep evidence of your US address, travel dates and reentry records, and ask Social Security how your own absences are treated before you apply. This article is general information, not legal advice.

Do you need work credits to get Medicare as a green card holder?

No, but work credits change the price and the timing. If you or your spouse have about 10 years of Medicare taxed work in the US, you can usually get premium free Part A at 65 without buying in, and then enroll in Part B. If you have some US work but not enough, CMS sets a reduced Part A premium of $311 a month in 2026 for people with at least 30 quarters of coverage, and a full premium of $565 for those with fewer.

Buying Part A also requires Part B. The regulation for bought Part A requires you to be enrolled in Part B, so budget for both premiums. If you worked abroad, ask Social Security whether any of that work can count; do not assume it does. The Ombrela glossary explains terms such as premium, deductible and coinsurance.

Can green card holders get Medicare at 65?

If you turn 65 after five years of continuous residence, yes: your Initial Enrollment Period is the usual seven months around your 65th birthday, and Medicare.gov says premium free Part A starts the month you turn 65 when you sign up in time. If you turn 65 before completing five years, you wait.

For people who first meet the requirements after 65, 42 CFR 407.14 builds the seven month window around the month you first become eligible, which for many green card holders is the month they complete five years of residence. Put that month on your calendar the day you receive your card, and contact Social Security about three months before it.

What happens if you miss your Medicare enrollment window?

Penalties can last a long time. Medicare.gov states that the Part B penalty adds 10% to your premium for each full year you could have signed up but did not, and you pay it for as long as you have Part B. If you must buy Part A and enroll late, your Part A premium may rise 10% for twice the number of years you delayed.

Medicare.gov also warns that if you miss your window you may have to wait to sign up, which can leave a gap in coverage. The simplest protection is to enroll during your first window unless you have qualifying coverage through current employment.

Did the 2025 budget law change Medicare for immigrants?

It narrowed eligibility for some noncitizens but kept green card holders. KFF reports that the 2025 reconciliation law limits Medicare eligibility to lawfully present immigrants who are lawful permanent residents, Cuban and Haitian entrants, or people living in the US under the Compacts of Free Association. The five year residence rule for people who buy in still applies. If your status is not a green card, check the current rules carefully.

How do you cover the years before Medicare eligibility?

The five years are a long time to go without insurance. Most recent arrivals over 65 rely on an ACA Marketplace plan, since people not enrolled in Medicare can buy one, pre-existing conditions are covered, and moving to the US from abroad opens a Special Enrollment Period. Savings depend on income, and KFF reports that from 2026 lawfully present immigrants with incomes below the poverty level lost access to subsidized Marketplace coverage.

For the first weeks after arrival, before a Marketplace plan begins, a short term bridge plan can cover new accidents and illnesses. These plans are designed for recent arrivals, exclude pre-existing conditions and have limits that tighten with age, so they are not a five year solution. Our guide to health insurance for green card holders over 65 compares these options, and our article on new immigrant insurance versus the ACA explains the tradeoffs.

What documents will Social Security ask for?

Expect to prove age, status and residence. Gather your birth certificate or passport, your green card, and records that show where you have lived since arrival, such as leases, utility bills, bank statements or tax returns. If you are applying on a spouse's work record, bring your marriage certificate and your spouse's Social Security number. Records should be originals or certified copies, and foreign documents may need translation.

Download our free Medicare eligibility timeline worksheet below. It helps you calculate your five year date, check work credits, compare premium free and bought Part A, map your enrollment window, plan coverage until you qualify and list the documents Social Security will ask for.

How to get covered

If you have just arrived and need cover while you apply for a Marketplace plan, enter your age, arrival date and citizenship on our new immigrant insurance quote page. Premiums depend on age, trip length, policy maximum and deductible, so compare live quotes and check the age limits for acute onset coverage.

Frequently Asked Questions

Can green card holders get Medicare without working in the US?

Yes, by buying it. A lawful permanent resident aged 65 or older who has lived in the US continuously for five years can buy Part A and enroll in Part B. In 2026, Medicare.gov lists bought Part A at $311 or $565 a month, depending on how long you or your spouse paid Medicare taxes, plus the standard Part B premium of $202.90.

Can I get Medicare through my spouse's work record?

Often, yes. Medicare.gov says most people get premium free Part A because they or a spouse paid Medicare taxes for at least about 10 years. If your spouse qualifies, you may be able to get premium free Part A at 65 without buying it. Social Security confirms eligibility based on the marriage and your spouse's record, so contact them before your enrollment window opens.

Does time on another visa count toward the five years?

The regulations require that you be a lawful permanent resident when you enroll and that you have resided in the US continuously for the five years before. They do not spell out how earlier time on a student or work visa is treated, so do not assume it counts. Ask Social Security to review your dates before you rely on them, and consider advice from an immigration attorney.

What happens to my coverage when I become eligible for Medicare?

You should enroll during your window and then end any Marketplace plan, because HealthCare.gov says Marketplace savings stop once Medicare coverage begins and you would pay full price. Time the switch so there is no gap: set the Marketplace end date to the day before Medicare starts, and consider Part D or other drug coverage at the same time.

Five years pass faster with a plan. Mark your eligibility month today, and if you have just arrived, compare new immigrant plans on Ombrela to cover the first weeks while longer term coverage begins.