Who Among Non-Citizens Still Qualifies for Medicare After the 2026 Law?

By Max Stephani

If you are a green card holder, the 2025 federal budget law did not take away your Medicare eligibility.

That is the first thing to know.

The law did, however, narrow Medicare eligibility for other lawfully present immigrants. Refugees, people granted asylum, TPS holders, humanitarian parolees, and several other groups can lose Medicare eligibility if they do not also have one of the immigration statuses protected by the new law.

For people already receiving Medicare, the change takes effect in January 2027. The Congressional Budget Office estimates that about 100,000 people will lose Medicare coverage because of the new immigration restrictions.

The rules for buying Medicare at 65 also remain important. For a non-citizen who does not qualify for premium-free Part A through their own or their spouse’s work record, lawful permanent residence and five years of U.S. residence can determine whether they can enroll.

Here is what the new rules mean for different immigration statuses.

Who can still qualify for Medicare?

Under H.R. 1, the 2025 budget law, Medicare eligibility for lawfully present non-citizens is now limited to:

• Lawful permanent residents, or green card holders
• Certain Cuban and Haitian entrants
• People lawfully residing in the U.S. under the Compact of Free Association, including citizens of the Marshall Islands, Micronesia and Palau

U.S. citizens and nationals remain eligible under the existing Medicare rules.

Other lawfully present immigrants are excluded from Medicare under the new definition. This includes refugees, people granted asylum, TPS holders, humanitarian parolees and certain survivors of human trafficking or domestic violence.

The restriction applies to new eligibility immediately under the law. People already receiving Medicare who are affected by the change can be terminated from coverage in early 2027, with the statutory 18-month date falling on January 4, 2027.

What if you have a green card?

You remain in the group that can qualify for Medicare.

Your green card itself is not enough to guarantee that Medicare will be free, though. Your age, work history, and whether you qualify through your own or a spouse’s work record still matter.

If you or your spouse have at least 40 quarters of Medicare-covered employment, you can generally qualify for premium-free Part A when otherwise eligible. Forty quarters is roughly 10 years of work in which Medicare taxes were paid.

If you do not have enough work credits and need to buy Part A, the five-year U.S. residency rule becomes important. A lawful permanent resident generally must have lived continuously in the United States for at least five years before applying for premium Part A.

So there are really two separate questions:

Can you qualify for Medicare?

And:

Do you qualify for premium-free Part A, or do you have to pay for it?

Do not confuse the two.

What if you are a refugee, asylee or another humanitarian immigrant?

This is where the new law makes a major difference.

Before the change, many lawfully present immigrants could qualify for Medicare if they met the normal age, disability and work-history requirements.

H.R. 1 narrows that eligibility.

Refugees, asylees, TPS holders, humanitarian parolees and several other lawfully present categories are no longer within the protected non-citizen groups unless they also have another qualifying status, such as lawful permanent residence.

If you are already enrolled in Medicare and your immigration status falls outside the new eligibility categories, you should expect a notice from the government before your coverage ends.

Do not ignore that notice.

If you are a refugee or asylee who is eligible to adjust status to a green card, obtaining lawful permanent residence can put you into the protected category. But immigration processing takes time, so this is not something to leave until the final months before the Medicare termination date.

If you receive a termination notice, consider speaking with an immigration attorney or qualified benefits counselor about your specific situation.

What if you are on H-1B, F-1 or H-4?

The important point is that the new law does not create a new Medicare right for these visa categories.

Work on an H-1B can still help you build the work credits needed for premium-free Part A if you later become eligible for Medicare through a qualifying immigration status.

For example, an H-1B worker who pays Medicare taxes for 10 years can build the 40 quarters normally used to qualify for premium-free Part A.

But those work credits do not override the immigration-status requirement.

If you remain in a temporary status that is outside the groups eligible under the new law, paying Medicare taxes does not by itself preserve Medicare eligibility.

This distinction is particularly important for immigrants who have worked in the U.S. for many years and assumed that paying Medicare taxes guaranteed coverage at retirement.

It does not.

What about F-1 students?

F-1 students can have a different payroll-tax situation.

Certain nonresident F-1 students are exempt from Social Security and Medicare taxes while they meet the requirements for the student exemption. Those exempt periods generally do not create Medicare work credits.

If you later change status and begin working in a position subject to Medicare taxes, those later years can build qualifying quarters.

So if you are an F-1 student planning to remain in the U.S. long term, do not assume that every year you spend in the country automatically counts toward Medicare.

What if you are turning 65 and recently got your green card?

This is where the rules can get confusing.

If you have enough qualifying work credits through your own employment or, where applicable, your spouse’s record, you may qualify for premium-free Part A without needing to rely on the five-year buy-in rule.

But if you do not have the required work history and need to purchase Medicare, a green card holder generally needs at least five years of continuous U.S. residence before applying.

That means someone who receives a green card shortly before turning 65 can face a very different situation from someone who has already lived in the U.S. for many years and then became a permanent resident.

There is another important point: the five-year residence period can sometimes include qualifying U.S. residence before the person actually received the green card. The rules are technical, so do not assume the clock automatically starts on the date printed on your green card.

How much does Medicare cost if you do not have 40 quarters?

For 2026, premium-free Part A is available to most people with at least 40 quarters of Medicare-covered employment.

If you have fewer qualifying quarters, you can still potentially buy Part A if you meet the eligibility requirements.

The 2026 monthly premiums are:

• 40 or more quarters: $0 Part A premium
• 30-39 quarters: $311 per month
• Fewer than 30 quarters: $565 per month

CMS confirms that these are the 2026 premium rates.

Part B is separate.

The standard 2026 Part B premium is $202.90 per month, with a $283 annual deductible. Higher-income beneficiaries pay more because of income-related adjustments.

And your spouse’s work history can matter. Under the Medicare rules, qualifying through a spouse can allow someone who has little or no qualifying work history of their own to receive premium-free Part A when the other eligibility requirements are met.

What happens if you delay Part B?

If you are eligible for Medicare and do not have qualifying employer coverage that allows you to delay enrollment, waiting too long to enroll in Part B can become expensive.

The standard Part B late-enrollment penalty is generally 10% of the standard premium for each full 12-month period you could have had Part B but did not enroll.

The penalty generally continues for as long as you have Part B.

There are exceptions, particularly for people covered by qualifying employer group health insurance after age 65, so do not assume that simply being employed means you should enroll immediately or that you can safely delay.

When can you sign up for Medicare?

Your first opportunity is the Initial Enrollment Period, which normally lasts seven months:

Three months before the month you turn 65 → the month you turn 65 → three months after.

Medicare says missing this window can result in a delay in coverage and late-enrollment penalties, depending on your circumstances.

The General Enrollment Period runs from January 1 through March 31 each year for people who missed their initial enrollment opportunity and do not qualify for a Special Enrollment Period.

Do not confuse this with Medicare’s fall Open Enrollment.

The October 15 to December 7 annual enrollment period is primarily for people who already have Medicare and want to change Medicare Advantage or Part D coverage. It is not the normal first-time enrollment period for someone turning 65.

The bottom line for immigrants

The new law creates a sharp distinction between immigration statuses.

Green card holders remain eligible for Medicare.

But refugees, asylees, TPS holders, humanitarian parolees and several other lawfully present immigrants can lose Medicare eligibility unless they also have a qualifying status under the new rules.

And for green card holders themselves, immigration status is only the first part of the calculation. Your work credits, spouse’s work history, age and length of U.S. residence can all affect when you can enroll and whether you have to pay a Part A premium.

If you are a non-citizen approaching Medicare age, the question is no longer simply “Did I pay Medicare taxes?”

You also need to check what immigration status you have when you apply, how many qualifying work quarters you have, whether your spouse’s record helps, and how long you have lived in the United States.

Those details can determine whether you get Medicare, whether you can buy it, and how much you pay.

Sources: 42 U.S.C. 1395mmm (H.R.1 Sec. 71201); CMS 2026 Medicare Parts A & B premiums fact sheet; CMS: Medicare enrollment (Original Part A & B); KFF: coverage loss under the 2025 law.