Medicare for Green Card Holders: 2026 Eligibility, Costs, and Enrollment

Do green card holders qualify for Medicare?

Yes. Lawful permanent residents (green card holders) can qualify for Medicare, but the path depends on your work history and how long you have lived in the United States. Medicare is not automatic for non-citizens the way it can be for many citizens.

There are two common situations. First, if you (or in some cases a current, former, or deceased spouse) earned at least 40 quarters of coverage — roughly 10 years of Medicare-taxed work — you are generally eligible for premium-free Part A at 65, similar to a citizen. Second, if you have fewer than 40 quarters, you may still enroll by paying premiums, but you must first meet a 5-year continuous U.S. residency requirement as a lawful permanent resident.

The 5-year continuous residency rule

For green card holders who do not qualify for premium-free Part A through work credits, federal rules require having resided in the United States as a lawful permanent resident for 5 continuous years before the month you file your Medicare application. This same 5-year requirement applies when buying into Part A and when enrolling in Part B without premium-free Part A.

If you reach 65 but have lived in the U.S. for fewer than 5 years, you typically must wait until you meet the residency test before you can enroll. During that gap, you may need other coverage — see the coverage-while-you-wait section below.

Part A costs in 2026: premium-free vs. buy-in

If you or a qualifying spouse have 40+ quarters of Medicare-taxed work, Part A (hospital insurance) is premium-free. If you have fewer credits, you can buy in by paying a monthly Part A premium once you meet the 5-year residency rule.

• 40+ quarters: premium-free Part A
• 30–39 quarters: $311/month Part A premium in 2026
• Fewer than 30 quarters: $565/month Part A premium in 2026
• Part A inpatient hospital deductible: $1,736 per benefit period
• Hospital days 61–90: $434/day coinsurance; lifetime reserve days: $868/day
• Skilled nursing facility days 21–100: $217/day coinsurance

Part B and Part D costs you'll also pay

Whether your Part A is premium-free or purchased, Part B (medical insurance) and Part D (drug coverage) carry their own costs. Most people pay the standard Part B premium; higher earners pay more through IRMAA (see below).

Part D drug plans are sold by private insurers, so specific premiums, covered drugs, and pharmacy networks vary by plan. The figures below are the standard national reference amounts — your actual plan costs may differ.

• Part B premium: $202.90/month (standard) in 2026
• Part B deductible: $283/year, then you generally pay 20% coinsurance for covered services
• Part D: a national base beneficiary premium of $38.99/month is used to calculate penalties; plan premiums vary
• Part D out-of-pocket cap: $2,100/year in 2026

When to enroll — and avoiding late penalties

Most people get a 7-month Initial Enrollment Period around their 65th birthday. If you are still working past 65 (or covered by a spouse's current employer group plan), you may delay Part B without penalty and use an 8-month Special Enrollment Period after that job-based coverage or employment ends.

If you miss your enrollment window and don't qualify for a Special Enrollment Period, you may have to wait for the General Enrollment Period (January 1–March 31) and could owe lifelong penalties. The Part B late enrollment penalty adds 10% to your premium for each full 12-month period you could have had Part B but didn't, and it lasts as long as you have Part B. The Part D penalty is 1% of the $38.99 base premium times the number of full months you went without creditable drug coverage.

Green card holders who immigrate later in life should note that the 5-year residency requirement can push back when enrollment is even possible — plan ahead so you enroll as soon as you become eligible.

Higher-income surcharges (IRMAA)

If your income is above certain thresholds, you pay an Income-Related Monthly Adjustment Amount (IRMAA) on top of standard Part B and Part D premiums. For 2026, IRMAA is based on your 2024 tax return and starts when modified adjusted gross income exceeds $109,000 (single) or $218,000 (married filing jointly).

With IRMAA, total Part B premiums range from $284.10 to $689.90 per month depending on income, and Part D adds a surcharge of $14.50 to $91.00 per month. Roughly 8% of people with Medicare pay these higher amounts.

Coverage options while you wait for eligibility

Green card holders who are 65 but haven't met the 5-year residency rule — or who are still building work credits — aren't necessarily without options. Lawfully present immigrants can often buy coverage through the Health Insurance Marketplace and may qualify for premium savings, even during the waiting period.

Because eligibility for other programs depends on income, household size, and state rules, confirm your specific situation with an official source before assuming you qualify. This guide is educational and independent; medicareloginguide.com is not affiliated with or endorsed by the federal government or any Medicare program.